History of All Medicine

EXISTENCE-OK

History of all Medicine

Natural History of Medicine

Integrative Medicine

Review Edited and Compiled Histories of Medicines by

Oko Offoboche

April 2022

existence-ok.com

Abstract: This is the History of every Medicine from the indigenes point of view and not another race or tribe smearing the other for dominance in Nature from the period of paradise through the time of good and evil, to correct the fall of the health of humankind back to the tree of life that is living with an addition of spirit instead of living carnally with soul alone. Humans become smarter when they live in their spirit that is all knowing to become true human beings. Read the Medicines traditional or/ and complementary to you.

Brief about the reviewser/ author/s:

Oko Offoboche was nominated as Head of Department by an Institute and University in the United States before he was awarded a Professorship in Philosophy of Metaphysics by a United States University; before then he had a Doctorate degree in Philosophy of Metaphysics, a Doctorate of Science in Information Systems, a Master of Science in Information Systems Management and bachelor degree in Information Systems and Metaphysics. Professor Offoboche has a degree in Acupuncture from a Nigerian College and an International diploma in Acupuncture from a University in Siri Lanka, an Advanced Certificate in Traditional Chinese Medicine in a Tianjin University in China, Diplomas in Natural Medicine from one of the old Academy in Lagos. Professor Oko Offoboche had a max CGPA. He is in many associations covering his disciplines internationally and locally. He was given professor status by the All Certified Professionals of Traditional, Complementary and Alternative Medicine, African University of Natural Medicine in view that is a branch of Nigerian Council of Physicians. He is a Fellow in many bodies including; Fellow of Association of Integrative Medicine Practitoners, Fellow of Institute Information Management, Fellow of Information Management Consultants. His late father was a medical doctor who specialized as a gyaenecologists with doctorate degree and his late grandfather was a revered native doctor.

Metaphysicians at a high level see what was already there before physical records were kept; that is why it was better for humankind that I compile all records of medicine for easy use by future generations. I implore the authors that it is better for students not to search for different parts of medicine, but be pleased their works were chosen to be like the bible (that was compiled) for medicine.

Why the author was proficient to write this?

met�a�phys�ics [m�ttə f�zziks]

noun

1. philosophy of being: the branch of philosophy concerned with the study of the nature of being and beings, existence, time and space, and causality (takes a singular verb)

2. underlying principles: the ultimate underlying principles or theories that form the basis of a particular field of knowledge (takes a plural verb)

�Symmetry is part of the metaphysics of quantum mechanics.

3. abstract thinking: abstract discussion or thinking (takes a singular verb)� ^c

Authors and works added by reviewer:

1. Dr. B. L. Dickson; The Black Race; DNA And Why!?

2. Rochelle Forrester; The History of Medicine

3. Wagner; The Origins and History of Medicine and Medical Practiced

4. History of use of Traditional Herbal Medicines

5. H. J. O'D. Burke-Gaffney; The history of medicine in the African countries

6. Ekeopara, Chike Augustine Ph.D1, Rev. Ugoha, Azubuike; The Contributions of African Traditional Medicine to Nigeria�s Health Care Delivery System; Origins of Traditional Medicine

7. WHO; Traditional and Modern Medicine: Harmonizing the Two Approaches

8. Caloriesmix; Daily Nutrition Fact

9. Thomas Nelson; A History of Medicine

10. Microsoft� Encarta� 2009. � 1993-2008 Microsoft Corporation: Circulation of the Blood, Physicians, Medical Ethics

11.Dr. Jenny Scutcliffe and Nanacy Duin; A History of Medcined

12.Tarik Catic, Ivona Oborovic, Edina Redzic, Aziz Sukalo, Armin Skrbo, Izet Masic; Traditional Chinese Medicine - an Overview

13. Ravishankar, B and Shukla, V.J.; INDIAN SYSTEMS OF MEDICINE: A BRIEF PROFILE

14. Yogacharya Dr Ananda Balayogi Bhavanani; YOGA THERAPY: AN OVERVIEW

15. Paolo Bellavite, Anita Conforti, Valeria Piasere and Riccardo Ortolani; Immunology and Homeopathy. 1. Historical Background

16. Urs Ha�feli; The History of Magnetism in Medicine

17. Florida Academy; The History of Massage Therapy

18. A van Tubergen, S van der Linden; A brief history of spa therapy

19. Jaime Schultz; A History of Kinesiology

20. Abb� Mermet; Radiesthesia History

21. Roy Porter, The Cambridge Illustrated History of Medicine

22. A Brief History of Aromatherapy

23. Music Therapy in Traditional African Societies: Origin, Basis and Application in Nigeria

24. Dariush Moza arian and David S. Ludwig, The 2015 US Dietary Guidelines � Ending the 35% Limit on Total Dietary Fat

25. Peter Whoriskey of Washignton Post, The U.S. government is poised to withdraw longstanding warnings about cholesterol - The Washington Post

26. Dr. Robert F. Stern and Mitchell Bebel Stargrove; The History of Naturopathic Medicine

27. Wikipedia; Asahi Health, Thalassotherapy, Imhotep, History of Acupuncture, Reflexology, Shiatsu, Traditional Tibetan medicine, Traditional Korean medicine, Indian Systems of Medicine: A Brief Profile, Siddha system of medicine, Unani system of medicine, List of forms of alternative medicine, Feng shui, Qigong, History of Use of Traditional Herbal Medicines, Herbal Medicine, Medicinal Plants, Origin of Traditional Medicine, Traditional Medicine, Traditional African Medicine, Alternative Medicine, Health in Nigeria, Healthcare in Nigeria, Siddha medicine, Crystal Healing is Metaphysics, The History of Physical Therapy, Electrohomeopathy, The Autogenic Training Method, Anthroposophy, Apitherapy, Bibliotherapy, Chelation therapy, Thai Massage, Japan Kampo, Reiki, Rolfing, Biodanza, Speleotherapy, Arab medicine, Unanai Medicine, Traditional Mongolian medicine, Herbal Medicine, Medicinal Plants, Traditional Medicine, Alternative Medicine, Health in Nigeria, A History of Metaphysics, Spiritual Medicine, Osteopathic Philosophy and History, Craniosacral therapy, Origins and History of Chiropractic, Electrohomeopathy, Bioresonance Therapy, Anthroposophic medicine, The Autogenic Training Method, Alexander Technique Science, Apitherapy, Aquatic therapy, Chromotherapy, Energy medicine, Feldenkrais Method, Horticultural therapy, Myofascial release, Hydrotherapy, Numerology, Orthopathy, Radionics, Urine therapy, Wellness (alternative medicine), A Brief History of Aromatherapy, Paraherbalism.

28. Oko Offoboche; existence-ok.com

Forward

Most Natural Medicine Professional Members have more than one discipline; Integrative Medicine is more than one form of Medicine by a practitioner of Medicine: it can be conventional (allopathic) medicine and complementary or traditional medicine. Many Natural Medicine Practitioners have qualifications to the highest level of scientific and arts degrees; that they know how to measure on ground in a way that it is the exact measure in the sky or depth of the sea by understanding gravity pressure on matter. Medicine starts from native medicine to traditional medicine to become complementary medicine. Conventional medicine is complementary to traditional medicine.

In Nigeria, Natural Medicine has scientists who have reached the top of their scientific field that came together to rescue African Traditional Medicine from extinction by allopathic physicians who allowed western influence dissuade them from their ancestral medicine, yet they need it more to have masters and PhD training status in Nigeria; contrary to their activities, pharmacists because of their masters that is pharmacognosy have aided in the development of traditional medicine. Although it was the professors of Medicine as Federal Ministers that agreed to all in TCAM that exists in Federal Ministry of Health in Nigeria which was because of their training requirements. When there was Ebola (another form of Lassa fever) in Lagos Nigeria, government physicians went on strike, private hospitals were open and natural medicine practitioners came to the rescue. As they are physicians with more than one form of medical background.

Most natural medicine practitioners produce remedies, but most allopathic physicians cannot produce drugs unlike their occidental or oriental colleagues that can produce medicinal substances to prove the name medicine. Bachelor degree medical practitioners are allowed to be called doctors because of continuous programme development (CPD) that makes them resident doctors until they have a PhD to be consultants.

The purpose of this compilation review work is not to mock the authors of the various works compiled here for easy use by medical students and professionals, the purpose of this work is to review the history of medicine from the point of the indigenes and/ or practitioners of the history written by adding the spiritual insight of the people of Africa at the time from thought forms that the conventional colonial medicine removed the spiritual part of medicine that was part of the way of the first practioners of science and medicine called alchemy, which is now dispirited as chemistry etc. Nothing written by the author was altered out of place, only those in the beginning on African had italic additions only from the point of the dark skinned Africans at the time, but for some all parts were not taken out, as the references on their work can only be on their work, because they were not required for the information to be reviewed. I thank the authors of all the works and I want them to know that I informed Copyright Clearance Centre and sent a message to every author that required it, if not all used here were referred to under the heading of their work and the reference here with the pagingnation superscripted after the title of the work in reference.

Prof. O. Offoboche

Preamble

Genesis 3:13-15 and Genesis 4:13-17

The Black Race; DNA And Why!? ^u

Summary:

"The white society needs Black people believing that we came from nothing more than slaves in order to maintain their dominance over us"!

Are you aware that DNA analysis performed upon mummies of several Egyptian Pharaohs in 2012 by DNA-tribes, an American based DNA analysis company, scientifically proven that the ancient Egyptians were in fact Africans?� Carbon date testings have also scientifically proven that the ancient kingdom was built by Africans thousands of years long before the Arabs and Europeans arrived theirs during the 7th century.

These scientific findings have been suppressed from mainstream media circulation to uphold the white society�s lies that the ancient Egyptians of Africa were ridiculously Europeans, and to conceal the fact that Africans were living in Pyramids while Europeans were still living in caves. White historians whitewashed ancient history to propagate the myth of white racial superiority over Black people. The white society needs Black people believing that our history is inferior to theirs in order to maintain their dominance over us. The practice is known as Orwellian propaganda. They therefore conceal the fact that Africans educated Greece�s first scholars, and civilized Europe; this included introducing science, mathematics, philosophy, art, agriculture and even the daily bath to Europeans.

�Those that know must teach.� - African Proverb

In 2012 and 2013 DNA tribes, an American company that specializes in DNA analysis, conducted testing on the mummies of Pharaoh Tutankhamen, Ramses III, Ramses IV and several others scientifically proven that the ancient Egyptians were in fact Africans. Their DNA matches proved that they belonged to human Y chromosome group E1b1a. This is the Y chromosome group of Black Sub Saharan Africans as pictured below.

Another group of mummies from the Amarna period of Egyptian pharaohs were also tested by DNA Tribes, in 2013. The conclusion of those testing were that those mummies autosomal profiles were also Africans. Their DNA profiles matches the present day populations of the African Great Lakes region and Southern Africa. Subsequent analysis of the autosomal profile of the mummy of Pharaoh Rameses III also concluded that his matched the genetic profiles of the population of the Great Lakes region Africans as well. These findings were reported in the DNA Tribe�s digest on February 2013. Carbon date testings have also scientifically proven that the ancient kingdom was built by Africans thousands of years long before the Arabs and Europeans arrived theirs during the 7th century. These scientific findings have been suppressed from mainstream media circulation to uphold the white society�s lies that the ancient Egyptians of Africa were ridiculously Europeans, and to conceal the fact that Africans were living in Pyramids while Europeans were still living in caves. White historians whitewashed ancient history to propagate the myth of white racial superiority over Black people. They conceal the fact that Africans educated Greece�s first scholars, and civilized Europe; this included introducing science, mathematics, philosophy, art, agriculture and even the daily bath to Europeans.

Although Egypt is located in Africa, and all of its Pyramids, and the Great Sphinx, were built by Africans thousands of years long before the Greeks and Arabs arrived there in the 7th century - this has been proven by carbon dating testings- the white society nonetheless will not acknowledge the ancient Egyptians of Africa were in fact Africans. This isn't because they don't know. White historians are well educated. They attend prestigious universities and are most certainly taught, within them that all of the great monuments of Africa�s ancient Egypt were already built, thousands of years, long before the arrivals of the Greeks and Arabs in the 7th century. Modern Egyptians are merely descendants from Arabs who whitened the population. In fact, the pyramids and the Sphinx were built thousands of years long before the arrival of any non-Africans into Africa. White historians know that the true and original Egyptians were in fact Africans, but conceals this fact from the public. Because they�ve deliberately stolen Africa�s glorious history of Egypt and falsely portrays it as being theirs. The practice is known as Orwellian propaganda.

Orwellian propaganda are societal conditions created and sustained by misinformation, distortions of facts, denial of truth, and even the manipulation of the past to falsely exalt the white society. White historians justifies these unethical practices as being merely the spoils of war; thus saying that it's customary for conquerors to distort facts and re-write history to favor themselves. However, the true reason it�s being done is much more nefarious and self-serving of the white society.

The true reason it�s being done is because white social scientists theorizes that a people�s future is predestined by the history they�re taught to believe about themselves. According to their theory a aspiring history is necessary to acquire a aspiring future because people references their future capabilities based upon their past achievements. It�s the process of imparting information which best enable people to realize their highest potential. People reference messages about their particular group to acquire their self-images and assess their potential and capabilities in relation to these messages. Also according to the theory, truth is not important to inspire a people�s future, what�s only important is what�s perceived as true. Because people function based upon their perceptions of what�s true rather than what�s actually is. Therefore, to give their racial group a past that inspires their future, white social scientists and white historians whitewashed the past. More specifically, they�ve made their racial group appear more significant throughout history than they truly were. Therefore, the collective self-esteems of Caucasians have been falsely bolstered at the expense of Africans.

Case Point and Proof:

Do you know that there exists substantial proof that the Great Sphinx of Giza is a sculpted head of an Black person?

There exist a reputable historian's eye witness account, written testimony and an artist rendering proving that the Great Sphinx is a sculpted head of an African Man? These are the types of evidence that a person might take to court to win their case. However, the system of white supremacy has always suppressed all evidence that contradicts the myth of white superiority and falsehood of Black inferiority. This includes hiding all evidence that the Sphinx is the sculpted head of a Black African.

Most of us have heard the story that when Napoleon's army arrive in Egypt on July 1 1798, he ordered that cannons be used to deface the Negroid face of the Great Sphinx of Giza. However, most people are not aware that there does exist substantial evidence proving that the face of the Sphinx was in fact an African Negroid man before it was defaced.

During the French invasion into Egyptian Napoleon was accompanied by a French diplomat, author, archaeologist and artist named Dominique Vivant Baron Denon.

Before the defacing of the Sphinx, Baron Denon asked Napoleon to allow him to first draw an illustration of the massive Sphinx of Giza before its face was destroyed. Napoleon agreed to the request and allowed Denon to draw a picture of the Sphinx before its defacement.�

Soon after Vivant�s sketch was complete Napoleon ordered the nose and lips shot off the Sphinx! Napoleon's objective for defacing the Sphinx was to remove the negro features. However, the true features of the Sphinx survived in the Vivant Denon drawing. This attached drawing of the Sphinx's is a true copy of that original sketch drawn by Denon. It's given signed completion date is July 1 1798. This date affirms that it was drawn shortly after the French invasion into Egypt. Vivant clearly captured the facial features of the Sphinx and they are clearly Negroid as stated by the eye witness Herodotus. The drawing shows that the Sphinx's features were clearly that of a Negroid African before it was damaged. Seeing the Sphinx with distinct negroid features also establishes that the ancient Egyptians were in fact a black culture.

This drawing was later published in the 1803 in an issue of Universal Magazine. Vivant Denon described the Sphinx as an African woman.

Here is also the written account about the Sphinx of Giza in Denon's own words:

�� "...Though its proportions are colossal, the outline is pure and graceful; the expression of the head is mild, gracious, and tranquil; the character is clearly African, but the mouth, and lips of which are thick as most Negroes, has a softness and delicacy of execution truly admirable; it seems real life and flesh.�� Art must have been at a high pitch when this monument was executed; for, if the head wants what is called style, that is the say, the straight and bold lines which give expression to the figures under which the Greeks have designated their deities, yet sufficient justice has been rendered to the fine simplicity and character of nature which is displayed in this figure..."

�� -- The Sphinx of Giza image (above) is from the Freeman Institute Black History Collection

Vivian Denon was a well-respected diplomat. He was appointed as the first Director of the Louvre French museum by Napoleon after the Egyptian campaign of 1798�1801, and his drawing of the Sphinx displaying its original Negroid features are commemorated in the Denon Wing of the modern museum.

He also wrote in his two-volume Voyage dans la basse et la haute Egypte ("Journey in Lower and Upper Egypt") published in 1802, that the original Egyptians were Black skin Negroes and that the sculpted face of the Sphinx was of the same Negro racial type before it was defaced by Napoleon's army.

�Dominique Vivant Baron Denon

continued to insist up until his death on 27 April 1825 that that the original face of the Sphinx was that of an African Negro before Napoleon had it was destroyed by cannon fire. In 1787, French orientalist Count Constantine de Volney travelled to Egypt and also described the population as "black with woolly hair", and "true Negroes of the same type as all native-born Africans". The reason why most Black people are unaware that there exist a reputable eye witness account, written testimony and an artist rendering affirming that the colossal Great Sphinx is in fact that of a Black African is because this information has been intentionally suppressed from the public distribution by the ruling elites.

When history's proven most nefariously deceitful and racist group controls the information, narratives, imageries that the world receives and perceives as true, they will naturally always manipulate and distort facts, and even history, to favor themselves. It's simply who they are, and the way they've always been. They have manipulated the entire world to see thing their way through Orwellian propaganda.

THE ORIGINAL NEFERTITI BUST IS A PROVEN FAKE. IT WAS CREATED BY A EUROPEAN ARTIST AND USED TO PROPAGATE THE FALSEHOOD THAT THE ANCIENT EGYPTIANS WERE EUROPEANS. THIS NEW BUST PROPAGATES THE SAME FALSEHOOD!

The original Bust of Nefertiti, from which this newly revealed bust is modeled after, has been proven to be an Egyptology Fraud created by an artist commissioned by Ludwig Borchardt. It was a deliberate attempt to make her look European.

According to a Swiss art historian, the bust is less than 100 years old. Henri Stierlin has said the stunning work that will later this year be the showpiece of the city's reborn Neues Museum was created by an artist commissioned by Ludwig Borchardt, the German archaeologist credited with digging Nefertiti out of the sands of the ancient settlement of Amarna, 90 miles south of Cairo, in 1912.

In his book, Le Buste de Nefertiti � une Imposture de l'Egyptologie? (The Bust of Nefertiti � an Egyptology Fraud?), Stierlin has claimed that the bust was created to test ancient pigments. But after it was admired by a Prussian prince, Johann Georg, who was beguiled by Nefertiti's beauty, Borchardt, said Stierlin, "didn't have the nerve to make his guest look stupid" and pretended it was genuine.

Berlin author and historian Edrogan Ercivan has added his weight to the row with his book Missing Link in Archaeology, published last week, in which he has also called Nefertiti a fake, modelled by an artist on Borchardt's statuesque wife.

Public and political enthusiasm about the find at the time gave the artefact its "own dynamic" and led to Borchardt ensuring it was kept out of the public gaze until 1924, the authors have argued.

He kept it in his living room for the next 11 years before handing it over to a Berlin museum, since when it has been one of the city's main tourist attractions.

The statue was famously admired by Adolf Hitler, who referred to it as "a unique masterpiece, an ornament, a true treasure".

THE NEFERTITI BUST IS FAKE

The archaeologist who claimed to have found the bust was actually going to reproduce a new sculptor of the Queen wearing a necklace he knew she had owned. He was also experimenting with colour tests with ancient pigments found at the digs. After completing the bust in 1912, the copy was admired so much by a German Prince; the Archaeologist couldn't sum up the courage to tell the Prince it was a fake.

THE SCIENTIFIC COMMUNITY KNEW THERE WERE HUGE ANOMALIES WITH THE BUST

'�The bust has no left eye and was never crafted to have one. This is an insult for an ancient Egyptian who believed the statue was the person themselves..." He also said the shoulders were cut vertically in the style practised since the 19th century while, "Egyptians cut shoulders horizontally" and that the features were accentuated in a manner recalling that of Art Nouveau. It was impossible to scientifically establish the date of the bust because it was made of stone covered in plaster, he said. "..The pigments, which can be dated, are really ancient.." he added.

ARCHAEOLOGIST AT THE TIME NEVER MENTIONED THE FIND AT THE SITE - IT WAS NEVER LISTED UNTIL 11 YEARS AFTER THE APPARENT DISCOVERY - THE ARCHAEOLOGIST DIDN'T EVEN SUPPLY A DESCRIPTION

Stierlin also listed problems he noted during the discovery and shipment to Germany as well as in scientific reports of the time. French Archaeologists present at the site never mentioned the finding and neither did written accounts of the digs. The earliest detailed scientific report appeared in 1923, 11 years after the discovery. The archaeologist "..didn't even bother to supply a description, which is amazing for an exceptional work found intact..". Borchardt 'knew it was a fake', Stierlin said. "..He left the piece for 10 years in his sponsor's sitting-room. It's as if he'd left Tutankhamen's mask in his own sitting-room.." .

Apart from anything else, the bust looks nothing like the 'real' Nefertiti images, it's as if someone has attempted to make her look European. The other pictured artifacts are true authenticated images of Nefertiti showing she's Black.

There is a relief depicting of Nefertiti that is carved from Limestone displaying her with prominent African features. It's kept at the Ashmolean Museum, Oxford

Archeologists also found a statute of the body of Queen Nefertiti from the Kingdom, Dynasty, reign of Amenophis IV-Akhenaten, BC Quartzite. The body of Nefertiti has a body shape that is clearly an Africans. It's kept at the Louvre Museum | Paris

There's also many more carvings and paintings depicting Nefertiti with her husband and children that are also all depicted as Africans. We've been bamboozled by whites. They've stolen our ancient African history and portrays it as theirs.

The white society sits upon a throne of white exalting lies created and sustained by Orwellian propaganda.

Case, Point, and Proof:

The white society teaches us that the world�s first scholars were the Greeks and that it was they that civilized the world. However, all of Europe�s Greek scholars received their formal education in Africa�s ancient Egypt. The Greeks openly admitted that their knowledge originated from Africa. When Isocrates wrote of his studies in the book Busirus, he said that �I studied philosophy and medicine in Africa�s Egypt.�

The white society teaches us that the father of medicine was a Greek named Hippocrates. However, the true father of medicine was an African named Imhotep. Imhotep was practicing medicine and writing on the subject 2,200 years before Hippocrates, the so called father of modern medicine, was even born. Imhotep is the author of an Egyptian medical text written on Papyrus, which contains almost 100 anatomical terms and describes 48 injuries and their treatment.

The history we�ve been taught also distorts many facts in order to give themselves credit for most inventions made by Black people.

Case Point and Proof:

White historians teach us that Thomas Edison is responsible for lighting up the world. But here are the facts to the contrary:

Thomas Edison and Lewis Latimer were both each simultaneously working on inventing their lightbulbs. Edison merely rushed to have his lightbulb patented first. However once Edison patented his lightbulb, NO companies purchased, nor mass produced it. Because it was deemed not efficient enough. It light very dimly and only lasted a few minutes. When Lewis Latimer patented his lightbulb it was deemed significantly more proficient, therefore it was purchased and mass produced. Lewis Latimer was also dispatched around the world to oversee the installations of his lightbulbs. Therefore, it was in fact Lewis Latimer that actually lit up the entire world. But because Latimer was Black, our racist whitewashed history books falsely claims that it was Edison that light up the world.

White historians also teach us that Henry Ford invented the first automobile. It was actually a African American inventor and carriage company entrepreneur named Charles Richard Patterson that built the first automobile. The C.R Patterson & son�s company starting out as a carriage building firm in 1873. In the early 1900�s Patterson and his son converted the company from a carriage business to a automobile manufacturer. It was released in 1905 and sold for $850. It had a four-cylinder Continental engine. C.R Patterson began making automobiles before Henry Ford and his automobiles were considered more sophisticated. C.R. Patterson and Sons were forced out of business by Henry Ford. In 1939, the company closed its big wooden doors.

But because Paterson was Black, our racist whitewashed history books falsely claims that it was Ford that invented the first automobile.

The hidden reality is that in spite of cultural traumas wrought by the injustices of white racism and slavery most inventions that have revolutionized the world were in fact either invented by a Black person, or were inspired by an earlier invention by a Black person. It�s actually the genius minds of Black people that moves the entire world forward.

�When a well-packaged web of lies has been sold gradually to the masses over generations, the truth will seem utterly preposterous and its speaker a raving lunatic.� -Dresden James.

I know that for some of you that declaration may be a hard pill to swallow, given how negatively Black people are depicted within the white society. We are constantly portrayed as the Blacks leeches of white society that benefits from the genius of white minds. However, the reality is the exact opposite from what the white society has manipulated so many to believe.

Here�s a relevant fact that they exclude from their whitewashed history books:

After slavery was abolished in the U.S. in 1865, beginning from 1870 and 1940, African Americans filed 726 invention patents. For a people to go directly from being enslaved - were they were denied an education - to then producing so much inventions in such a short time span is astounding. Furthermore, those numbers of patent applications submitted by African Americans more than doubled those submitted by whites during the same time frame. Even while being enslaved many Africans invented many things, but the patent rights were awarded to their white slave owners.

As stated earlier: Most inventions that have revolutionized the world were in fact either invented by a Black person, or were inspired by an earlier invention by a Black person.

Case, Point, and Proof:

If you enjoy using the internet thank

Philip Emeagwali, a Nigerian computer scientist, is regarded by many as being the father of the Internet. He invented the super computer in 1987. It was his formula that used 65,000 separate computer processors to perform 3.1 billion calculations per second in 1989. That feat led to computer scientists comprehending the capabilities of supercomputers and the practical applications of creating a system that allowed multiple computers to communicate. Philip Emeagwali also invented the accurate weather forecasting system in 1990. He also used his mathematical and computer expertise to develop methods for extracting more petroleum from oil fields.

If you enjoy sending emails thank a African American name Emmit McHenry. McHenry created a complex computer code whereby ordinary people can now surf the web or have e-mails without studying computer science. He created what we know today simply as .com.

If you enjoy your digital cellphone thank an African American name Jesse Eugene Russell.� He is an inventor and electrical engineer that invented digital cellular technology. He pioneered the field of digital cellular communication in the 1980s through the use of high power linear amplification and low bit rate voice encoding technologies and received a patent in 1992 (US patent #5,084,869) for digital cellular base station design. Jesse Russell holds several patents and is a key person to the invention of the modern cell phone.

� If you enjoy using your PC monitor thank an African American named Dr. Mark Dean. Dean is the Inventor/Computer scientist and engineer responsible for developing a number of landmark technologies, including the modern color PC monitor, the Industry Standard in 1981. In 1999, Dean also led a team of programmers to develop one of the stepping stones of modern day computer technology� the first gigahertz chip. The CMOS microprocessor chip is remarkable because it processed a billion calculations and large amounts of data in a second. Dean hold 20 individual patents.

If you enjoy using your GPS thank Gladys Mae West - an African American mathematician known for her contributions to the mathematical modeling of the shape of the Earth, and her work on the development of the satellite geodesy models that were eventually incorporated into the Global Positioning System (GPS).

Without Black people there would not exist skyscrapers. This is because Black people invented the elevator, the air conditioning, and central heating. Alexander Miles invented the Elevator, Fredrick Jones invented the air condition, and Alice Parker, a Black woman, invented the heating furnace in 1919 which provided central heating.

Dr. Thomas O. Mensah is a Ghanaian born chemical engineer and inventor. Is the inventor of fiber optics and nanotechnology. He was awarded 7 USA and worldwide patents in fiber optics. In all, he has some 14 patents.

Dr. Patricia Bath, an African American scientist invented, and patented in 1988 the cataract laserphaco probe that help save the eye sight of millions. Millions of people around the world unknowingly owes their eyes sight to this Black woman.

Mark Hannah developed the 3D graphics technology that now used in many major Hollywood movies

Shirley Ann Jackson made several telecommunications breakthroughs which led to the touch-tone phone, caller I.D. and call waiting.

Marie Van Brittan Brown invented the home surveillance security system.

Henry Sampson invented the non-digital cellular phone in 1983.

Did you know that the Sanitary Pad was developed by a Black woman name Mary Beatrice Davidson. Until sanitary pads were created, women used all kinds of reusable fabrics to absorb menstrual flows.

Mary's invention was initially rejected. The first company that showed interest rejected it because of racial discrimination. The world had no choice, her invention was too important to be ignored. It was later accepted in 1956, 30 years later. She received five patents for her inventions. One of her other inventions is the bathroom tissue holder, which she co-invented with her sister. The patent number was US 4354643.

There is more:

Gerald A Lawson invented the first home video game system with inter changeable cartridges.

Percy L. Julian invented the process of synthesis which led to the birth control pill and improvement in cortisone production.

There is more:

Matthew A. Cherry, is the inventor of the tricycle. In May 1888, Cherry received his patent for the tricycle.

G.T. Sampson invented the clothes drier in 1892.

George R. Carruthers invented the ultra-violent camera spectrograph�

In1885, two Black inventors, L S. Burridge and N.R. Marsham, invented the typewriter

J. Gregory invented the motor

Six African Americans scientists were essential in the making of the first atomic bomb. One was J. Ernest Wilkins, one of the world�s leading mathematicians who earned his PhD at the age of seventeen.

Alexander Miles invented the Elevator and safety devices for elevator.

Patent no 371,207

Alice Parker, a Black woman, is credited with inventing the heating furnace in 1919 which provided central heating.

Garret A. Morgan invented the automatic traffic signal and the gas mask.

Edmond Berger invented the spark plug.

J.B. Winters invented the fire escape ladder.

John L. Love invented the Pencil sharpener 23- 11-189 Patent # 594114.

Fredrick Jones invented the air conditioner.

John A. Johnson invented the wrench

John Standard invented the refrigerator

Lewis Howard Latimer invented the electric lamp and the filament for the light bulbs.

The small Pox Inoculation method was brought from Africa by African named Onesimus

Phillip Downing invented the letter drop mail box 10-27-1892

John Burr invented the Lawn mower

Marjorie Joyner holds the patent for the permanent hair wave machine.

Lloyd Hall created the chemical compound that preserves meat

S.H. Love invented improvements to military guns 22-4-1919

S.H. Love invented improvements to the vending machine 1-21-1933��

�W.A. Lovette invented the advanced printing press

Thomas J. Martin invented the fire extinguisher 3-261872

W.D. Davis invented the riding saddle 10-6-1895

There is more:

Do you know that the first successful open heart surgery on this planet was performed by a Black surgeon within a Black owned Hospital?

Dr. Daniel Hale Williams

(1856-1931) founded Provident Hospital and Training School for Nurses (the first black-owned hospital in America) in 1891.

And he performed the first successful open heart surgery in 1893. Following the surgery white surgeons from around the country and the world came to learn from Dr Williams. Many white surgeon had attempted the surgery early but their patients died.

In 1940, Dr. Charles Drew, another African American doctor achieved yet another medical pioneering break through. In his short life of only 46 years, Charles revolutionized blood storage. His refrigerated �blood mobiles� stored blood at a temperature to prolong its shelf life. This further revolutionized blood storage and plasma banks for WWII.

WHILE INSPIRING THEIR RACIAL GROUP THEY DO THE OPPOSITE TO BLACK PEOPLE BY TEACHING US THAT AFRICANS WERE UNCIVILIZED AND ILLITERATE BEFORE THE EUROPEANS INVADED, AND THEREFORE HAS NO SIGNIFICANT HISTORY:

But here are the facts to the contrary:

The first being that the world�s oldest university is located in Africa.

Timbuktu University:

The Timbuktu University (in Mali, Africa) and its library are older than any of those found within the Western world. It was composed of three schools, namely the Masajid of Djinguereber, the Masajid of Sidi Yahya, and the Masajid of Sankore. During the 12th century, the university had an enrollment of around 25,000 students from Africa. In Timbuktu, there are about 700,000 surviving books. They are written in Mande, Suqi, Fulani, Timbuctu, and Sudani. The contents of the manuscripts include math, medicine, poetry, law and astronomy. This work was the first encyclopedia in the 14th century before the Europeans got the idea later in the 18th century, 4 centuries later.

Furthermore, long before the Europeans invaded Africa, it was Africans- when we called ourselves Moors - that civilized Europe. This included introducing science, math, philosophy, and even the daily bath to Europeans.� Queen Isabella of Spain bragged that she had only bathed twice in her whole life. Queen Elizabeth I, claimed that she was the cleanest woman in all of Europe, for reportedly bathing once a month.

There�s More:

Africa is also the cradle of mathematics.

The world�s oldest mathematical tools were discovered in Africa.

The Ishango Mathematic Tool.

The Ishango Mathematical Tool was invented by Africans dating as far back as 22000 years ago, in the Upper Paleolithic era. The Ishango tool is an attestation of the practice of arithmetic in ancient Africa.

There was also discovered in Africa another mathematical tool.

The Lebombo Mathematical Tool.

The Lebombo Tool is indeed the oldest known mathematical artifact in the world. It is even older than the Ishango bone. Discovered in the 1970s in Border Cave, a rock shelter on the western scarp of the Lebombo Mountains in an area near the border of South Africa and Swaziland (now Eswatini).

Great Zimbabwe:

Great Zimbabwe is an ancient city in the south-eastern hills of Zimbabwe near Lake Mutirikwe and the town of Masvingo - originally called the Shona civilization. The stone city spans an area of 7.22 square kilometres (2.79 square miles) which, at its peak, could have housed up to 18,000 people.

These gigantic brick buildings and walls were erected nearly 2000 years ago. It is recognized as a World Heritage site by UNESCO.

The world�s largest man made structure was built by Africans:

There exist in Africa within the ancient Nigerian city of Benin the ruins of a Great Wall four time larger than the Great Wall of China.

The Great Wall of Benin in Edo state Nigeria was the largest man made structure in the history of the world. The walls are four times longer than the Great Wall of China and consumed 100 times more materials than the pyramid of Giza. The walls extended for some 16,000 kilometers in all and covered a space of 6,500 square miles. It is estimated that it took over 150 million hours of digging to construct and were all built by the Edo people.

In all, they are four times longer than the Great Wall of China, and consumed a hundred times more material than the Great Pyramid of Cheops. It�s perhaps the largest single archaeological phenomenon on the planet.� Source: Wikipedia, Architecture of Africa.� Fred Pearce the New Scientist 11/09/99.

Even before the full extent of the city walling had become apparent the Guinness Book of Records carried an entry in the 1974 edition that described the city as: �The largest earthworks in the world carried out prior to the mechanical era.� � Excerpt from �The Invisible Empire�, PD Lawton, African Historical Ruins.

Sadly, in 1897, Benin City and its Great Wall was destroyed by British forces under Admiral Harry Rawson - in what has come to be called the Punitive expedition. The city was looted, blown up and burnt to the ground. This expedition destroyed about 1,100 years of Benin history and one of the evidence of African civilization. The expeditionary force was made up of 1,200 British soldiers.

It brought an end to the great Benin Kingdom and led to the looting numerous Benin historical artefacts. A collection of the famous Benin Bronzes are now in the British Museum in London. Part of the 700 stolen bronzes by the British troops were sold back to Nigeria in 1972.

The monumental building achievements of Africa�s ancient Egyptians also proves that Africans were not illiterate nor uncivilized.

All that we learn from the oppressors are lies that falsely exalts themselves and falsely marginalizes us. The collective self-esteems of the white masses have been falsely bolstered at the expense of the collective self-esteems of the Black masses.

The white educational system�s failure to adequately provide Black students with a racially affirming curriculum as it routinely does for White students is actually essential for maintaining white dominance. Because for a ruling class to maintain its position of social dominance over its oppressed population, they must condition the oppressed from a very early age to accept their own subordinate status and to adhere to the authority of the dominant society.

To do so, the education given to the oppressed, from the time that their minds are young and most impressionable, must be the type that denies them of a racially and culturally affirming curriculum. When the oppressed population is denied a fully racially and culturally affirming education, even the brightest among them may have little, if any, hope of mentally extracting themselves from their assigned low, dominated position in life.

Dr. B. L. Dickson

Metaphysics/ Spirituality

Contents��

Abstract

Author/s (Reviewer)...........................................................................................................................................................................

Forward................................................................................................................................................................................................

Preamble...........................................................................................................................................................................................

Content............................................................................................................................................................................................

1.0 History of Medicine..............................................................................................................................................................

�� 1.1.0 Learning Objectives...........................................................................................................................................................

�� 1.1.0.1 List of forms of alternative medicine....................................................................................................................

�� 1.1.0.2 Introduction...............................................................................................................................................................

�� 1.1.0.3 Post Colonial Medicine error..................................................................................................................................

1.2.0 Medicine in Africa ...............................................................................................................................................................

�� 1.2.0.1 Eden............................................................................................................................................................................

�� 1.2.0.2 Egypt.................................................................................................................................................................................

�� 1.2.0.3 Imhotep......................................................................................................................................................................

�� 1.2.0.4 Colonial Medicine Influence...................................................................................................................................

1.2.1 Mesopotamian...........................................................................................................................................................................

1.2.2 Israeli/ Palestinian.....................................................................................................................................................................

�� 1.2.2.1 Thalassotherapy..............................................................................................................................................................

1.2.3 Chinese Medicine..............................................................................................................................................................

�� 1.2.3.1 Traditional Chinese Medicine - an Overview.......................................................................................................

�� 1.2.3.2 History of Acupuncture...........................................................................................................................................

�� 1.2.3.3 Feng shui....................................................................................................................................................................

�� 1.2.3.4 Qigong......................................................................................................................................................................

�� 1.2.3.5 Reflexology............................................................................................................................................................

�� 1.2.3.6 Shiatsu....................................................................................................................................................................

1.2.4 Traditional Tibetan medicine........................................................................................................................................

1.2.5 Traditional Korean medicine.........................................................................................................................................

1.2.6 Indian Medicine...............................................................................................................................................................

�� 1.2.6.1 Indian Systems of Medicine: A Brief Profile....................................................................................................

�� 1.2.6.2 Siddha system of medicine................................................................................................................................

�� 1.2.6.3 Unani system of medicine..................................................................................................................................

�� 1.2.6.4 Yoga Therapy: An Overview...............................................................................................................................

�� 1.2.6.5 Siddha medicine...................................................................................................................................................

1.2.7 Thai Massage...................................................................................................................................................................

1.2.8 Japan Kampo....................................................................................................................................................................

�� 1.2.8.1 Reiki........................................................................................................................................................................

1.2.9 Rolfing...............................................................................................................................................................................

1.2.10 Greco-Roman Medicine...............................................................................................................................................

�� 1.2.10.1 Asahi Health........................................................................................................................................................

�� 1.2.10.2 Biodanza......................................................................................................................................................................

�� 1.2.10.3 Speleotherapy....................................................................................................................................................

1.2.10.1 Dark Ages....................................................................................................................................................................

1.2.10.2 Arab medicine ...........................................................................................................................................................

�� 1.2.10.2.1 Unanai Medicine ...........................................................................................................................................

1.2.10.3.1 Medieval European medicine .............................................................................................................................

1.2.10.3.2 Traditional Mongolian medicine.........................................................................................................................

1.3.0 The Renaissance..............................................................................................................................................................

�� 1.3.1 Circulation of the Blood.........................................................................................................................................

�� 1.3.2 Jenner and vaccination...........................................................................................................................................

�� 1.3.3 The discovery of anaesthesia ...............................................................................................................................

�� 1.3.4 The Germ Theory of Disease.................................................................................................................................

�� 1.3.5 Antiseptics................................................................................................................................................................

�� 1.3.6 Antibiotics.................................................................................................................................................................

�� 1.3.7 Medical Statistics.....................................................................................................................................................

�� 1.3.8 Diagnostic Technology...........................................................................................................................................

�� 1.3.9 Modern Surgery.......................................................................................................................................................

2.0 Analysis of the order of discovery in the history of medicine ...................................................................................

2.1 ��The Origins & History of Medical Practice & Fundamentals of Medical Practice Management................

�� 2.2 ��History of Use of Traditional Herbal Medicines .................................................................................................

�� 2.3 ��Herbal Medicine.......................................................................................................................................................

�� 2.4 ��Paraherbal Medicine...............................................................................................................................................

�� 2.5 ��Medicinal Plants.......................................................................................................................................................

�� 2.6 ��Origin of Traditional Medicine .............................................................................................................................

�� 2.7 ��Contributions of Traditional Medicine to Healthcare Development ............................................................

�� 2.8 ��Traditional Medicine...............................................................................................................................................

�� 2.8.1 Traditional African Medicine.................................................................................................................................

�� 2.9 ��Traditional and Modern Medicine: harmonizing the two approaches(Summary)......................................

3.0 Alternative Medicine.........................................................................................................................................................

�� 3.1 Health in Nigeria.........................................................................................................................................................

�� 3.2 Healthcare in Nigeria.................................................................................................................................................

4.0 Traditional and Modern Medicine: harmonizing the two approaches(Meeting)...................................................

�� 4.1 ��A History of Metaphysics.......................................................................................................................................

�� 4.1.1 Spiritual Medicine...................................................................................................................................................

�� 4.1.2 Crystal Healing is a Metaphysics Diploma course......................................................................................................

�� 4.2 ��The History of Naturopathic Medicine.................................................................................................................

�� 4.3 ��The history of Naprapathy..............................................................................................................................................

�� 4.4 ��The History of Physical Therapy.............................................................................................................................

�� 4.5 ��Osteopathic Philosophy and History.....................................................................................................................

�� 4.6 ��Craniosacral therapy................................................................................................................................................

�� 4.7 ��Origins and History of Chiropractic.......................................................................................................................

�� 4.8 ��Immunology and Homeopathy..............................................................................................................................

�� 4.9 ��Electrohomeopathy..................................................................................................................................................

�� 4.10 The History of Magnetism in Medicine................................................................................................................

�� 4.11 A Brief History of Aromatherapy...........................................................................................................................

�� 4.12 The History of Massage Therapy...........................................................................................................................

�� 4.13 A brief history of spa therapy.................................................................................................................................

�� 4.14 A History of Kinesiology..........................................................................................................................................

�� 4.15 Radiesthesia History................................................................................................................................................

�� 4.16 Bioresonance Therapy.............................................................................................................................................

�� 4.17 Anthroposophic medicine.......................................................................................................................................

�� 4.18 The Autogenic Training Method..........................................................................................................................

�� 4.19 A Historical Look at Rudolf Steiner, Anthroposophy, and Waldorf Education..............................................

�� 4.20 Music Therapy in Traditional African Societies.............................................................................................

�� 4.21 Alexander Technique Science................................................................................................................................

�� 4.22 Apitherapy.................................................................................................................................................................

�� 4.23 Aquatic therapy........................................................................................................................................................

�� 4.24 Bibliotherapy.............................................................................................................................................................

�� 4.25 Chelation therapy.....................................................................................................................................................

�� 4.26 Chromotherapy.........................................................................................................................................................

�� 4.27 Energy medicine.......................................................................................................................................................

�� 4.28 Feldenkrais Method.................................................................................................................................................

�� 4.29 Horticultural therapy...............................................................................................................................................

�� 4.30 Hydrotherapy............................................................................................................................................................

�� 4.31 Myofascial release....................................................................................................................................................

�� 4.32 Numerology...............................................................................................................................................................

�� 4.33 Orthopathy................................................................................................................................................................

�� 4.34 Radionics....................................................................................................................................................................

�� 4.35 Urine therapy............................................................................................................................................................

�� 4.36 Wellness (alternative medicine)............................................................................................................................

�� 4.37 History of Reflexology.............................................................................................................................................

5.0 History of Natural Medicine ............................................................................................................................................

6.0 Physicians.............................................................................................................................................................................

�� 6.1 Clinical Trials........................................................................................................................................................................

�� 6.2 Medical Ethics.............................................................................................................................................................

7.0 References...........................................................................................................................................................................

�� Art of reviewer

1.0 History of Medicine ^z

Medicine (Latin medicus, �physician�), the science and art of diagnosing, treating, and preventing disease and injury. ^c

Natural Medicine begins after paradise, when good and evil began. But to understand why natural medicine is of nature, we have to go all the way to when paradise began that caused creation; which allowed the immunity of humanity to weaken because of carnal living instead of spiritual living that came because the way to life (that is spirit) was cut off after the fall of the first man to attain spiritual completion. This made man prone to diseases.� The Universe has viruses that are formed by the reaction of particles in space that falls into our atmosphere around 800,000,000 (eight hundred million) a day, in which plants that are always outside make direct contact with them and the most effective plant amongst them to overcome anyone of them is the very plant used to treat the sick.

1.1.0 Learning Objectives ^d:

➤ Appreciate natural medicine and medical practice history.

➤ Explore the domains of natural medicine and medical practice management.

➤ Understand the natural forces of change affecting natural medicine practice.

➤ Develop natural perception on changes affecting natural medical practice.

➤ Comprehend the significance of the natural medical practitioner.

1.1.0.1 List of forms of alternative medicine ^w (although WHO has dropped alternative, it is used because of the author)

Some with history and origin in the list of articles covering alternative medicine topics are used.

Activated charcoal cleanse

Acupressure

Acupuncture

Affirmative prayer

Alexander technique

Alternative cancer treatments

Animal-Assisted Therapy

Anthroposophical medicine

Apitherapy

Applied kinesiology

Aquatherapy

Aromatherapy

Art Therapy

Asahi Health

Astrology

Attachment therapy

Auriculotherapy

Autogenic training

Autosuggestion

Ayurveda

Bach flower therapy

Balneotherapy

Bates method

Bibliotherapy

Biodanza

Bioresonance therapy

Blood irradiation therapies

Body-based manipulative therapies

Body work (alternative medicine) or Massage therapy

Chelation therapy

Chinese food therapy

Chinese herbology

Chinese martial arts

Chinese medicine

Chinese pulse diagnosis

Chakra

Chiropractic

Chromotherapy (color therapy, colorpuncture)

Cinema therapy

Coding (therapy)

Coin rubbing

Colloidal silver therapy

Colon cleansing

Colon hydrotherapy (Enema)

Craniosacral therapy

Creative visualization

Crystal healing

Cupping

Dance therapy

Detoxification

Detoxification foot baths

Dietary supplements

Dowsing

Ear candling

Earthing

Eclectic medicine

Electromagnetic therapy

Electrohomeopathy

Equine-assisted therapy

Energy medicine

�� Magnet therapy

�� Reiki

�� Qigong

�� Shiatsu

�� Therapeutic touch

�� Energy psychology

Faith healing

Fasting

Feldenkrais Method

Feng shui

Five elements

Flower essence therapy

Functional medicine

German New Medicine

Grahamism

Grinberg Method

Gua sha

Graphology

Hair analysis (alternative medicine)

Hatha yoga

Havening

Hawaiian massage

Herbalism

�� Herbal therapy

�� Herbology

Hijama

Holistic living

Holistic medicine

Homeopathy

Home remedies

Horticultural therapy

Hydrotherapy

Hypnosis

Hypnotherapy

Introspection rundown

Iridology

Isolation tank

Isopathy

Jilly Juice

Laughter therapy

Light therapy

Macrobiotic lifestyle

Magnetic healing

Manipulative therapy

Manual lymphatic drainage

Martial arts

Massage therapy

Massage

Medical intuition

Meditation

�� Mindfulness meditation

�� Transcendental meditation

�� Vipassana

Meridian (Chinese medicine)

Mega-vitamin therapy

Mind�body intervention

�� Alexander technique

�� Aromatherapy

�� Autogenic training

�� Autosuggestion

�� Bach flower therapy

�� Feldenkrais method

�� Hatha yoga

�� Hypnotherapy

Moxibustion

Myofascial release

Naprapathy

Natural Health

Natural therapies

Naturopathic medicine

New thought

Neuro-linguistic programming

Nutritional healing

Nutritional supplements

Numerology

Orthopathy

Osteopathy

Pilates

Postural Integration

Pranic healing

Prayer

Psychic surgery

Prokarin

Paula method healing exercises

Qigong

Quantum healing

Radionics

Rebirthing

Recreational Therapy

Reflexology

Reiki

Rolfing Structural Integration

Rosen Method

Salt Therapy

Self-hypnosis

Shiatsu

Siddha medicine

Sonopuncture

Sound therapy

Spiritual mind treatment

Structural Integration

Support groups

T'ai chi ch'uan

Tantra massage

Tao yin

Thai massage

Thalassotherapy

Therapeutic horseback riding

Therapeutic touch

Tibetan eye chart

Traditional Chinese medicine

History of traditional Chinese medicine

Traditional Korean medicine

Traditional Japanese medicine

Traditional Mongolian medicine

Traditional Tibetan medicine

Trager approach

Transcendental meditation

Trigger point

Tui na

Unani medicine

Urine therapy

Uropathy

Vaginal steaming

Vegetotherapy

Visualization (cam)

Visualization

Water cure (therapy)

Wellness (alternative medicine)

Wuxing (Chinese philosophy)

Yoga

�� Ashtanga yoga

�� Amrit yoga

�� Ashtanga vinyasa yoga

�� Bikram yoga

�� Hatha yoga

�� Iyengar yoga

�� Kundalini yoga

�� Siddha yoga

�� Sivananda yoga

�� Tantric yoga

�� Viniyoga

�� Vinyasa yoga

�� Yoga Therapy

�� Daoyin Taoist Yoga

Zang fu

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1.1.0.2 Introduction ^m

Illness and injury are as old as fallen humankind. Though, true humanity should normally not be measured by human remains but by artifact, because human beings were not dying until humankind�s fall; Stone Age human remains show evidence of diseases such as arthritis, tuberculosis, inflammations, dental problems, leprosy bone tumours, scurvy, spinal tuberculosis, cleft spine, osteomyelitis, sinusitis and various congenital abnormalities and injuries. These illnesses show in human skeletal remains and if more complete human remains were available, it is likely a much greater span of diseases would be apparent. Agreed that human beings do not like pain, death and suffering there was a clear need to try and find a cure for diseases and injuries.

The curing and prevention of disease usually involves an explanation of the cause of the disease. In the absence of knowledge of germs (bacteria and viruses) and of human anatomy and physiology stone age humans ascribed disease, injuries and death to supernatural forces, just as other inexplicable events such as storms, earthquakes and volcanic eruptions were considered to be caused by supernatural forces. This lead to the need for a method of influencing the supernatural forces which required a person with knowledge of the supernatural world who could communicate with and placate the gods or spirits that caused the disease and injury. Priests, shamans, witch doctors and medicine men were often responsible for protecting the health of Stone Age humans by means of appropriate rituals and spells. A cave painting of what is considered to be a Stone Age medicine man dating from around 15,000 BCE is on the cave walls of the Les Trois Freres cave in the Pyrenees.

Stone Age medicine men would most likely have supplemented their spells and rituals with the use of various herbs, roots, leaves and animal parts and other medicines. Given the body�s natural tendency to heal itself and placebo effects, to the non-spiritual they will think it would have been difficult for pre-historic healers to work out whether their spells and herbs were actually working, but in truth, by their spirit they knew. Colonial medicine taught that only in recent times with modern written records, statistical techniques and double blind studies involving control groups, can it be reasonably clear if a particular medicine is working.

The earliest clear example of a surgical operation is trepanning which involves boring a hole into the skull. This operation was first carried out in Neolithic times using stone tools. Some of the patients survived as shown by healing around the holes and some skulls even had several holes bored in them, indicating repeated operations. It is not clear why such a painful operation was carried out, but it may have been to allow evil spirits that were causing migraines, epilepsy or madness to escape from the patient�s skull. It is also likely other surgical operations, such as the lancing of abscesses and the sewing up of wounds with bone or flint needles, were performed, but there is no clear evidence of this.

�

��

Trepanned Skull ^C

Trepanning, the procedure of cutting a hole in the skull, is the earliest known medical operation. Some anthropologists believe that trepanning was performed on people with mental illnesses to drive out evil spirits from their heads. This skull dates from the Inca civilization.

Daniele Pellegrini/Photo Researchers, Inc.

When nomadic hunter-gatherers first began to settle in permanent villages, which grew into towns and then cities, new health problems arose. Large numbers of people concentrated in small areas meant disease would quickly spread through populations.� The domestication of animals resulted in many diseases spreading from animals to humans such as measles, smallpox and tuberculosis from cattle and flu from pigs and dogs. However, a further result from living in cities was the development of writing which allowed a more organized medical profession and the possibility of accurate recording of symptoms and remedies.

Writing began in Mesopotamia before 3,000 BCE when it was invented by the ancient Sumerians. The Sumerians wrote on clay tablets and one such tablet contains lists of drugs, chemical substances and plants used for medical purposes. Magic and religion however played a major role in Mesopotamian medicine as injury and disease were considered to be caused by gods, demons, evil spirits and witchcraft. Numerous magic spells, incantations and sacrifices were available to combat particular diseases and correct recitation was necessary for an effective cure. Whether a patient would survive or not could be divined by examining the liver of a sacrificed sheep or goat. The Code of Hammurabi, a law code made by a Babylonian King, sets out medical fees for various services and penalties for errors made by the doctor. Services referred to involved, the opening of an abscess, the treatment of broken limbs, eyes and intestinal complaints.

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1.1.0.3 Post-Colonial Medicine Error

They also made mistakes with a lot of fatalities with their industrialization, but such mistakes are not put in simple history, but only when you choose to study more. But for medicines in Africa, they stigmatized them in history, forgetting that you do not insult the place of your fore father's that your ancestors migrated from, because it backfires. It is not true that post-colonial medicine is the best medication, because nature that is original, produces the best medicine that complements the harm of the treatment that synthetic medicine does not do.

Modern medicine or better put, post-colonial medicine (because the medical practices was for their economic colonization of the minds of other races), also made terrible mistakes that were not physically done on the scull but were physically done on the body of the person by their dietary guidelines mistakes:

The U.S. government is poised to withdraw longstanding warnings about cholesterol ^x

The nation�s top nutrition advisory panel has decided to drop its caution about eating cholesterol-laden food, a move that could undo almost 40 years of government warnings about its consumption.

The group�s ﬁnding that cholesterol in the diet need no longer be considered a �nutrient of concern� stands in contrast to the committee�s ﬁndings ﬁve years ago, the last time it convened. During those proceedings, as in previous years, the panel deemed the issue of excess cholesterol in the American diet a public health concern.

The ﬁnding follows an evolution of thinking among many nutritionists who now believe that, for

healthy adults, eating foods high in cholesterol may not signiﬁcantly affect the level of cholesterol in the blood or increase the risk of heart disease.

The greater danger in this regard, these experts believe, lies not in products such as eggs, shrimp or lobster, which are high in cholesterol, but in too many servings of foods heavy with saturated fats, such as fatty meats, whole milk, and butter.

[Scientists have ﬁgured out what makes Indian food so delicious]

The new view on cholesterol in food does not reverse warnings about high levels of �bad� cholesterol in the blood, which have been linked to heart disease. Moreover, some experts warned that people with particular health problems, such as diabetes, should continue to avoid cholesterol-rich diets.

While Americans may be accustomed to conﬂicting dietary advice, the change on cholesterol comes from the inﬂuential Dietary Guidelines Advisory Committee, the group that provides the scientiﬁc basis for the �Dietary Guidelines.� That federal publication has broad effects on the American diet, helping to determine the content of school lunches, affecting how food manufacturers advertise their wares, and serving as the foundation for reams of diet advice.

The panel laid out the cholesterol decision in December, at its last meeting before it writes a report that will serve as the basis for the next version of the guidelines. A video of the meeting was later posted online and a person with direct knowledge of the proceedings said the cholesterol ﬁnding would make it to the group�s ﬁnal report, which is due within weeks.

After Marian Neuhouser, chair of the relevant subcommittee, announced the decision to the panel at the December meeting, one panelist appeared to bridle.

�So we�re not making a [cholesterol] recommendation?� panel member Miriam Nelson, a Tufts University professor, said at the meeting as if trying to absorb the thought. �Okay ... Bummer.�

Members of the panel, called the Dietary Guidelines Advisory Committee, said they would not comment until the publication of their report, which will be ﬁled with the Department of Health and Human Services and the Department of Agriculture.

[Here�s what the government�s dietary guidelines should really say]

While those agencies could ignore the committee�s recommendations, major deviations are not common, experts said.

Five years ago, �I don�t think the Dietary Guidelines diverged from the committee�s report,� said Naomi K. Fukagawa, a University of Vermont professor who served as the committee�s vice chair in 2010. Fukagawa said she supports the change on cholesterol.

Walter Willett, chair of the nutrition department at the Harvard School of Public Health, also called the turnaround on cholesterol a �reasonable move.�

�There�s been a shift of thinking,� he said.

But the change on dietary cholesterol also shows how the complexity of nutrition science and the lack of deﬁnitive research can contribute to confusion for Americans who, while seeking guidance on what to eat, often ﬁnd themselves aﬂoat in conﬂicting advice.

Cholesterol has been a ﬁxture in dietary warnings in the United States at least since 1961, when it appeared in guidelines developed by the American Heart Association. Later adopted by the federal government, such warnings helped shift eating habits -- per capita egg consumption dropped about 30 percent -- and harmed egg farmers.

Yet even today, after more than a century of scientiﬁc inquiry, scientists are divided.

Some nutritionists said lifting the cholesterol warning is long overdue, noting that the United States is out-of-step with other countries, where diet guidelines do not single out cholesterol. Others support maintaining a warning.

The forthcoming version of the Dietary Guidelines -- the document is revised every ﬁve years -- is expected to navigate myriad similar controversies. Among them: salt, red meat, sugar, saturated fats and the latest darling of food-makers, Omega-3s.

As with cholesterol, the dietary panel�s advice on these issues will be used by the federal bureaucrats to draft the new guidelines, which offer Americans clear instructions -- and sometimes very speciﬁc, down- to-the-milligram prescriptions. But such precision can mask sometimes tumultuous debates about nutrition.

�Almost every single nutrient imaginable has peer reviewed publications associating it with almost any outcome,� John P.A. Ioannidis, a professor of medicine and statistics at Stanford and one of the harshest critics of nutritional science, has written. �In this literature of epidemic proportions, how many results are correct?�

Now comes the shift on cholesterol.

Even as contrary evidence has emerged over the years, the campaign against dietary cholesterol has continued. In 1994, food-makers were required to report cholesterol values on the nutrition label. In

2010, with the publication of the most recent �Dietary Guidelines,� the experts again focused on the problem of "excess dietary cholesterol."

Yet many have viewed the evidence against cholesterol as weak, at best. As late as 2013, a task force arranged by the American College of Cardiology and the American Heart Association looked at the dietary cholesterol studies. The group found that there was �insuﬃcient evidence� to make a recommendation. Many of the studies that had been done, the task force said, were too broad to single out cholesterol.

�Looking back at the literature, we just couldn�t see the kind of science that would support dietary restrictions,� said Robert Eckel, the co-chair of the task force and a medical professor at the University of Colorado.

The current U.S. guidelines call for restricting cholesterol intake to 300 milligrams daily. American adult men on average ingest about 340 milligrams of cholesterol a day, according to federal ﬁgures. That recommended ﬁgure of 300 milligrams, Eckel said, is " just one of those things that gets carried forward and carried forward even though the evidence is minimal.�

"We just don't know," he said.

Other major studies have indicated that eating an egg a day does not raise a healthy person�s risk of heart disease, though diabetic patients may be at more risk.

�The U.S. is the last country in the world to set a speciﬁc limit on dietary cholesterol,� said David

Klurfeld, a nutrition scientist at the U.S. Department of Agriculture. �Some of it is scientiﬁc inertia.�

The persistence of the cholesterol fear may arise, in part, from the plausibility of its danger.

As far back as the 19th century, scientists recognized that the plaque that clogged arteries consisted, in part, of cholesterol, according to historians.

It would have seemed logical, then, that a diet that is high in cholesterol would wind up clogging arteries.

In 1913, Niokolai Anitschkov and his colleagues at the Czar�s Military Medicine Institute in St. Petersburg, decided to try it out in rabbits. The group fed cholesterol to rabbits for about four to eight weeks and saw that the cholesterol diet harmed them. They ﬁgured they were on to something big.

�It often happens in the history of science that researchers ... obtain results which require us to view scientiﬁc questions in a new light,� he and a colleague wrote in their 1913 paper.

But it wasn�t until the 1940s, when heart disease was rising in the United States, that the dangers of a cholesterol diet for humans would come more sharply into focus.

Experiments in biology, as well as other studies that followed the diets of large populations, seemed to link high cholesterol diets to heart disease.

Public warnings soon followed. In 1961, the American Heart Association recommended that people reduce cholesterol consumption and eventually set a limit of 300 milligrams a day. (For comparison, the yolk of a single egg has about 200 milligrams.)

Eventually, the idea that cholesterol is harmful so permeated the country's consciousness that marketers advertised their foods on the basis of "no cholesterol."

What Anitschkov and the other early scientists may not have foreseen is how complicated the science of cholesterol and heart disease could turn out: that the body creates cholesterol in amounts much larger than their diet provides, that the body regulates how much is in the blood and that there is both �good� and �bad� cholesterol.

Adding to the complexity, the way people process cholesterol differs. Scientists say some people � about 25 percent -- appear to be more vulnerable to cholesterol-rich diets.

�It�s turned out to be more complicated than anyone could have known,� said Lawrence Rudel, a professor at the Wake Forest University School of Medicine.

As a graduate student at the University of Arkansas in the late 1960s, Rudel came across Anitschkov�s paper and decided to focus on understanding one of its curiosities. In passing, the paper noted that while the cholesterol diet harmed rabbits, it had no effect on white rats. In fact, if Anitschkov had focused on any other animal besides the rabbit, the effects wouldn't have been so clear -- rabbits are unusually vulnerable to the high-cholesterol diet.

�The reason for the difference -- why does one animal fall apart on the cholesterol diet -- seemed like something that could be ﬁgured out,� Rudel said. �That was 40 or so years ago. We still don�t know what explains the difference.�

In truth, scientists have made some progress. Rudel and his colleagues have been able to breed squirrel monkeys that are more vulnerable to the cholesterol diet. That and other evidence leads to their belief that for some people -- as for the squirrel monkeys -- genetics are to blame.

Rudel said that Americans should still be warned about cholesterol.

�Eggs are a nearly perfect food, but cholesterol is a potential bad guy,� he said. �Eating too much a day won�t harm everyone, but it will harm some people.�

Scientists have estimated that, even without counting the toll from obesity, disease related to poor eating habits kills more than half a million people every year. That toll is often used as an argument for more research in nutrition.

Currently, the National Institutes of Health spends about $1.5 billion annually on nutrition research, an amount that represents about 5 percent of its total budget.

The turnaround on cholesterol, some critics say, is just more evidence that nutrition science needs more investment. Others, however, say the reversal might be seen as a sign of progress.

�These reversals in the ﬁeld do make us wonder and scratch our heads,� said David Allison, a public health professor at the University of Alabama at Birmingham. �But in science, change is normal and expected.�

When our view of the cosmos shifted from Ptolemy to Copernicus to Newton and Einstein, Allison said, �the reaction was not to say, �Oh my gosh, something is wrong with physics!� We say, �Oh my gosh, isn�t this cool?� �

Allison said the problem in nutrition stems from the arrogance that sometimes accompanies dietary advice. A little humility could go a long way.

�Where nutrition has some trouble,� he said, �is all the conﬁdence and vitriol and moralism that goes along with our recommendations.�

The 2015 US Dietary Guidelines � Ending the 35% Limit on Total Dietary Fat ^y

Every 5 years, the US Departments of Agriculture and Health and Human Services jointly release the Dietary Guidelines for Americans. These guidelines have far-reaching inﬂuences across the food supply, including for schools, government cafeterias, the military, food assistance programs, agricultural production, restaurant recipes, and industry food formulations. An accurate revision of the Dietary Guidelines is crucial to the health of millions of people. Integral to this process is the Dietary Guidelines Advisory Committee (DGAC) report, just released, prepared by appointed scientists who systematically review the literature and provide evidence-based recommendations to the Secretaries of Agriculture and Health and Human Services. In the coming months, the Secretaries will review the DGAC recommendations; consider comments from the public, academics, advocacy groups, and industry; and ﬁnalize the Dietary Guidelines.

In the new DGAC report, one widely noticed revision was the dropping of dietary cholesterol as a �nutrient of concern.� This surprised the public, but is concordant with scientiﬁc evidence demonstrating no appreciable relationship between dietary cholesterol and serum cholesterol or clinical cardiovascular events in general populations. The DGAC should be commended for this evidence-based change.

A far less noticed, but more momentous, change was the new absence of any limitation on total fat consumption. The DGAC neither listed total fat as a nutrient of concern, nor proposed any limitation on its consumption. Rather, they concluded, �Reducing total fat (replacing total fat with overall carbohydrates) does not lower CVD risk Dietary advice should put the emphasis on optimizing types of dietary fat and not reducing total fat.� Limiting total fat was also not recommended for obesity prevention; instead, the emphasis was on evidence-based healthful food-based diet patterns higher in vegetables, fruits, whole grains, seafood, legumes, and dairy products; and lower in meats, sugar-sweetened foods and drinks, and reﬁned grains.

With these quiet statements, the DGAC boldly reversed nearly 4 decades of focus on reducing total fat. Starting in 1980, the Dietary Guidelines emphasized limiting dietary fat, initially to <30% of calories and then, in 2005, to between 20�35% of calories. Throughout, the main rationale was to lower saturated fat and dietary cholesterol, rather than any clear evidence for direct harms of total fat. This reasoning overlooked the complex lipid and lipoprotein effects of saturated fat, including minimal effects on Apo-B in comparison to carbohydrate; this explains why substitution of saturated fat with carbohydrate does not lower cardiovascular risk. Moreover, a global limit on total fat inevitably lowers intake of unsaturated fats, among which nuts, vegetable oils, and ﬁsh are particularly healthful. Most relevantly, this limitation did not account for harms of starches and sugars, the most common replacement when dietary fat is reduced. Indeed, the 1980 Dietary Guidelines recommended that intake of �complex carbohydrates� be increased, largely based on theoretical considerations (carbohydrate contains fewer calories per gram than does fat) instead of evidence for health beneﬁts.

As with other scientiﬁc ﬁelds from physics to clinical medicine, nutritional science has advanced dramatically in recent decades. The 2015 DGAC report, for the ﬁrst time, is consistent with the accumulated evidence for lack of eﬃcacy of recommending high-carbohydrate, low-fat diets to the general population for any major endpoint, including heart disease, stroke, cancer, diabetes, or obesity.

Related to this, the 2015 DGAC renews the 2005 and 2010 Dietary Guidelines call to restrict both added sugars and reﬁned grains. For decades, complex carbohydrates were considered a foundation of a healthful diet, e.g. as evidenced by the Food Guide Pyramid base. This was revised in 2005, based on consistent evidence for harms of starches and sugar. Yet, reﬁned grains continue to represent the largest category of calories in the US food supply, including white bread, white rice, and most chips, crackers, cereals, and bakery desserts. Both industry and consumers have been unsuccessful in meaningfully reducing reﬁned carbohydrates, a failure likely exacerbated by decades of focus on lowering total dietary fat. Recognizing this harmful confusion, the 2015 DGAC speciﬁcally concludes that, �consumption of �low-fat� or �nonfat� products with high amounts of reﬁned grains and added sugars should be discouraged.� Yet, more than 70% of Americans continue to exceed the optimal amount of reﬁned grain consumption. Dropping the limitation on total fat should make it easier for industry, restaurants, and the public to increase healthful fats and proteins while reducing reﬁned grains and added sugars.

The US Departments of Agriculture and Health and Human Services should follow the evidence-based, scientiﬁcally sound DGAC report and remove any limit on total fat consumption in the ﬁnal 2015 Dietary Guidelines. Yet, this represent only one policy tool to inﬂuence American diets, and others should follow suit. For example, the Nutrition Facts Panel, separately regulated by the US Food and Drug Administration, lists % daily values for several key nutrients on packaged foods. Remarkably, this Panel still has not been updated to revise the outdated 30% limit on dietary fat, obselete for almost 15 years. The Nutrition Facts Panel should now be revised to drop total fat, as well as dietary cholesterol, from among the listed nutrients, while adding contents of both reﬁned grains and added sugars. Notably, only adding added sugars, a current proposed change, insuﬃciently acknowledges the harms of � and implicitly encourages � the intake of reﬁned grains. The US Department of Agriculture should also modernize its Smart Snacks in School standards, removing the 35% restriction on total fat from the criteria. The Institute of Medicine should also update its report, now nearly 15 years old, on dietary reference intakes for energy, total fat, and other macronutrients.

The current restriction on total fat affects virtually all aspects of the American diet, including school meals (which currently ban whole milk, but allow sugar-sweetened non-fat milk), government procurement for oﬃces and the military, meals for the elderly, and guidelines for food assistance programs that together provide 1 in 4 meals consumed in the US. The restriction on fat also drives food industry formulations and marketing, as evidenced by the heavy promotion of fat-reduced desserts, snacks, salad dressings, processed meats and other products of questionable nutritional value. Not surprisingly, a majority of Americans are still actively trying to avoid dietary fat, which is typically replaced by reﬁned carbohydrates including highly processed grains, potato products, and added sugars. The limit on total fat presents an impediment to public health, promoting harmful low-fat foods, encouraging high intakes of starch and sugar, and discouraging the restaurant and food industry from providing products and meals high in healthful fats. Based on the accumulated new scientiﬁc evidence, the Dietary Guidelines for Americans, Nutrition Facts Panel, Smart Snacks in School standards, and Institute of Medicine should remove the 35% limit on total dietary fat. This scientiﬁcally sound change will have major positive inﬂuences on the US food supply, food industry formulations and marketing, and public perception and understanding of evidence-based dietary priorities.

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1.2.0 Medicine in Africa (Eden extension)

Eden (most of it is in Nigeria and then most of Cameroon as the center and extending to other countries around Africa)

The place of language and migration origin is the origin of humanity. That is where you can trace the true origin of Medicine, which is why it started that was to complement the fall of humans from life that is spirit that did everything. Nigeria is clearly the most cursed land on Earth that shows from the failed state of governance to the waste of human capital because of indigenes that want to stick to their status quo; Nigerians are the most educated group in the USA, yet in the most educated state in Nigeria that every family has a professor, they are the most poor in unutilized potential.

After which people were driven to the east as stated in religious scriptures, in which Sumerians began the physical way of living with the hardship of the curse. Any Occidental disputing this should ask the skilled orients where most of their techniques originated from that the Orientals perfected.

�^c

Bantu Migration

Today, close to 100 million people across the southern half of Africa speak related languages, collectively known as Bantu languages. Linguistic evidence shows that the root Bantu language emerged in what is now Nigeria and Cameroon by 2000 bc. By 1000 bc, in a series of migrations, Bantu speakers had spread south to the savanna lands of Angola and east to the Lake Victoria region. Over the next 1500 years they scattered throughout central and southern Africa, interacting with and absorbing indigenous populations as they spread.

�^�C

Ancient Routes of Migration

Physical barriers, including deserts, mountain ranges, and bodies of water, inhibited ancient people�s migrations. In addition, migrating groups tended to seek a habitat similar to the ones they had left.

The dark Africans that remained in the heat that caused the Sahara Desert to separate the rest of the world from sub-Saharan Africa, learnt better hygiene like brushing, washing and bathing that they taught the occidentals when the dark skinned Africans were called the Moors. Now, online, the moors have been manipulated to be the Arabs only; the question everyone should think about is how can there be mud in the Middle East. Mud is in the swampy areas that are a lot in West Africa and Central Africa where the Moors were. Most of the idols of gods are seen with wooly hair and big broad nose in Scotland, Mexico etc. Even the bible has the Ethiopian teaching what Jesus (Prophet Isa) meant n the Acts of the Apostles. Also the independence of Nigeria has been manipulated online from the original eleven names of ten men and one woman.

Health Care: -

1. Brushing: brush the front of the teeth up and down, brush the crown, brush the back of the teeth outwards, and then brush your tongue looking at the mirror. Then, pull on the mucus and phlegm in the throat to remove bad breath. The villagers in sub-Saharan Africa always used water to rinse their mouth after eating. Brush the back of the tongue to remove mouth ordour and uncomfortable feeling in the mouth.

2. Shaving: shave downwards, clean-shave (shave downwards then, upwards) for those that don't develop bumps (hair growing inwards)

3. Cutting hair: it is best to trim the hair than to shave-off the hair around the body or the head, your hair is for a purpose. The style of cutting the side of the hair lower than the rest of the hair by the whites was done by the dark skinned Africans when they were looked up to by the Arcadians.

4. Bathing: wash your face twice with soap as you bathe if you have oily skin, once for dry skin, bathe twice or thrice a day. Always scrub the soles of your feet at least once a week. Wash your hair with a lot of soap to lather and there will be no dandruff. Use sponge to scrub of dead old skin to prevent body odor. Blow your nostrils with water while bathing or after a dusty environment. Dropping castor oil at night before you sleep clears worms etc. from the eyes after about six months.

5. If the urge to go to toilet comes in uncomfortable circumstances, lay down with your belly facing upwards and it will subside the feeling; but if your stomach is troubling you, lay with your stomach downwards and it will reduce. Which delays you until the right circumstances to use the toilet or the person getting the medication are available.

6. When you sleep and in your dreams, you are always caught or you do not win, straighten your legs and you will always win and will never be caught.

7. When eating an orange cut twice, giving four parts, bite the center of the fruit and pull your teeth to the central part of the fruit that was cut to take out all the seeds, then you can enjoy the seedless fruit.

The colonialist humiliation of the dark skinned as not able to have developed any structure, is the loss of their knowledge about the sprit and soul treatment, as they only treat the body, so their psychology cannot treat the mind effectively but suppress the information when the spirit should have been let to treat the mind. Those who left from Africa to stay abroad do not know the knowledge of the spirit like their traditional rulers that are not allowed to leave the thrown to stay abroad because the knowledge is passed down to the leaders. Everyone in the village is trained by their family to be a native doctor by showing them the plants in their native dialect and their medicinal value to keep them always well, where those who know more than others that pass down that knowledge to their descendants (either by prayer or laying of hands as it was with Abraham to Jacob in the Bible or Koran) are regarded as the native doctor of the village that knows more; those without western civilization do not know sickness until something alien enters their community, because of the herbs they eat in their food that has usually all the required nutrients and medication they need with assorted meats from water, land and air. Which is contrary to the colonialists� false information that they passed to their government to allow colonization and use of the human resources that coveted their neighbours goods. Yet science proves that Homo Sapiens are those that left from Africa as Bible Enoch etc. to populate the rest of the world by inter breeding with other species.

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1.2.0.1 Egypt ^m

Our knowledge of ancient Egyptian medicine comes from certain medical papyri and from the embalming of Egyptsian dead. The papyri contain various descriptions of magic spells designed to drive out the demon causing a particular disease and of various prescriptions, including the dosage for particular diseases. Drugs used included castor oil, hartshorn, bile and fat from animals and copper sulphate. Treatment was prescribed for wounds and bruises and surgical instruments appear to have been used and broken bones were treated with splints. The ancient Egyptians made shoes for each foot, one for the left and the right, based on spiritual insight; contrary to the colonialist shoe making that was designed for both legs that are usually not the same.

The Egyptian practice of embalming and the favourable conditions of Egypt for the natural preservation of bodies shows us some of the diseases the Egyptians suffered from. Arthritis and inflammation of the periosteum and osteomyelitis were common. Spinal deformations and spinal tuberculosis, gout and virulent osteomas have been found in Egyptian mummies. Tooth decay was as common as in modern times and there is good evidence of kidney stones and gall stones, appendicitis and stomach and intestinal troubles. The lower classes in particular suffered from infectious diseases such as plague, smallpox, typhus, leprosy, malaria, amoebic dysentery and cholera and various parasitic diseases. The Egyptian embalming is based on the idea of them returning to their alien leaders.

Egyptian physician�s knowledge of anatomy was not extensive despite the practice of embalming. This is because embalming was carried out by specialist technicians and not by physicians. Knowledge of internal organs was largely limited to an awareness of their outward appearance.

1.2.0.3 Imhotep ^w

Imhotep (/ɪmˈhoʊtɛp/; Ancient Egyptian: ỉỉ-m-ḥtp "the one who comes in peace"; ﬂ. late

27th century BCE) was an Egyptian chancellor to the Pharaoh Djoser, possible architect of

Djoser's step pyramid, and high priest of the sun god Ra at Heliopolis. Very little is known of

Imhotep as a historical ﬁgure, but in the 3,000 years following his death, he was gradually

gloriﬁed and deiﬁed.

Imhotep

Ancient Egyptian: Jj m ḥtp

Burial place�� Saqqara (probable)

Other names�� Asclepius (name in Greek) Imouthes (also name in Greek)

Occupation�� chancellor to the Pharaoh Djoser and High

Priest of Ra

Years active�� c. 27th century BCE

Known for�� Being the architect of Djoser's step pyramid

�

Greek Manetho variants:

Africanus: Imouthes Eusebius: missing Eusebius, AV: missing

Traditions from long after Imhotep's death treated him as a great author of wisdom texts and especially as a physician. No text from his lifetime mentions these capacities and no text mentions his name in the ﬁrst 1,200 years following his death. Apart from the three short contemporary inscriptions that establish him as chancellor to the Pharaoh, the ﬁrst text to reference Imhotep dates to the time of Amenhotep III (c. 1391�1353 BCE). It is addressed to the owner of a tomb, and reads:

�

The wab-priest may give offerings to your ka. The wab-priests may stretch to you their arms with libations on the soil, as it is done for Imhotep with the remains of the water bowl.

� Wildung (1977)

It appears that this libation to Imhotep was done regularly, as they are attested on papyri associated with statues of Imhotep until the Late Period (c. 664�332 BCE). Wildung (1977) explains the origin of this cult as a slow evolution of intellectuals' memory of Imhotep, from his death onward. Gardiner ﬁnds the cult of Imhotep during the New Kingdom (c. 1550�1077 BCE) suﬃciently distinct from the usual offerings made to other commoners that the epithet "demigod" is likely justiﬁed to describe his veneration.

The ﬁrst references to the healing abilities of Imhotep occur from the Thirtieth Dynasty (c. 380�343 BCE) onward, some 2,200 years after his death.

Imhotep is among the few non-royal Egyptians who were deiﬁed after their deaths, and until the 21st century, he was one of nearly a dozen non-royals to achieve this status. The center of his cult was in Memphis. The location of his tomb remains unknown, despite efforts to ﬁnd it. The consensus is that it is hidden somewhere at Saqqara.

Historicity

Imhotep's historicity is conﬁrmed by two contemporary inscriptions made during his lifetime on the base or pedestal of one of Djoser's statues (Cairo JE 49889) and also by a graﬃto on the enclosure wall surrounding Sekhemkhet's unﬁnished step pyramid. The latter inscription suggests that Imhotep outlived Djoser by a few years and went on to serve in the construction of Pharaoh Sekhemkhet's pyramid, which was abandoned due to this ruler's brief reign.

Architecture and engineering

�

The step pyramid of Djoser

Imhotep was one of the chief oﬃcials of the Pharaoh Djoser. Concurring with much later legends, egyptologists credit him with the design and construction of the Pyramid of Djoser, a step pyramid at Saqqara built during the 3rd Dynasty. He may also have been responsible for the ﬁrst known use of stone columns to support a building. Despite these later attestations, the pharaonic Egyptians themselves never credited Imhotep as the designer of the stepped pyramid, nor with the invention of stone architecture.

Deiﬁcation

God of medicine

Two thousand years after his death, Imhotep's status had risen to that of a god of medicine and healing. Eventually, Imhotep was equated with Thoth, the god of architecture, mathematics, and medicine, and patron of scribes: Imhotep's cult was merged with that of his own former tutelary god.

He was revered in the region of Thebes as the "brother" of Amenhotep, son of Hapu � another deiﬁed architect � in the temples dedicated to Thoth.: v3, p104. Because of his association with health, the Greeks equated Imhotep with Asklepios, their own god of health who also was a deiﬁed mortal.

According to myth, Imhotep's mother was a mortal named Kheredu-ankh, she too being eventually revered as a demi-goddess as the daughter of Banebdjedet. Alternatively, since Imhotep was known as the "Son of Ptah",: v?, p106 his mother was sometimes claimed to be Sekhmet, the patron of Upper Egypt whose consort was Ptah.

Post-Alexander period

The Upper Egyptian Famine Stela, which dates from the Ptolemaic period (305�30 BCE), bears an inscription containing a legend about a famine lasting seven years during the reign of Djoser. Imhotep is credited with having been instrumental in ending it. One of his priests explained the connection between the god Khnum and the rise of the Nile to the Pharaoh, who then had a dream in which the Nile god spoke to him, promising to end the drought.

A demotic papyrus from the temple of Tebtunis, dating to the 2nd century CE, preserves a long story about Imhotep. The Pharaoh Djoser plays a prominent role in the story, which also mentions Imhotep's family; his father the god Ptah, his mother Khereduankh, and his younger sister Renpetneferet. At one point Djoser desires Renpetneferet, and Imhotep disguises himself and tries to rescue her. The text also refers to the royal tomb of Djoser. Part of the legend includes an anachronistic battle between the Old Kingdom and the Assyrian armies where Imhotep ﬁghts an Assyrian sorceress in a duel of magic.

As an instigator of Egyptian culture, Imhotep's idealized image lasted well into the Roman period. In the Ptolemaic period, the Egyptian priest and historian Manetho credited him with inventing the method of a stone-dressed building during Djoser's reign, though he was not the ﬁrst to actually build with stone. Stone walling, ﬂooring, lintels, and jambs had appeared sporadically during the Archaic Period, though it is true that a building of the size of the step pyramid made entirely out of stone had never before been constructed. Before Djoser, Pharaohs were buried in mastaba tombs.

Medicine

Egyptologist James Peter Allen states that "The Greeks equated him with their own god of medicine, Asklepios., although ironically there is no evidence that Imhotep himself was a physician."

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1.2.0.4 Colonial Medicine Influence ^T

This is a comprehensive survey of the colonial history of medicine in some seventeen African countries that would be monumental where the colonialist emotionally thought for the people as God had cursed; and is proposed to take as a theme a pattern which runs throughout the story, a pattern which� seems to� indicate� that� the� short� history� of medicine in the Commonwealth� countries� in Africa-for� in its significant aspects it spans little more than� a century-is� largely the history� of their medical services; and it is the development� of medicine� through� those� services that� I shall try to� sketch very broadly and with, inevitably, many gaps.

Before the opening of Africa to exploration, settlement, trade and missionary enterprise, the African people were not exposed to tremendous stresses and the mortality was immense. For medical treatment, they relied upon their indigenous practitioners, usually-although not�� always accurately-referred to as witch-doctors. These medicine-men practiced largely by spiritual suggestion, incantations, charms and remedies; but with their knowledge of herbs and roots, they often discovered by intuition, which the colonial medical practitioners saw as perhaps by serendipity, a number of effective indigenous drugs.� Some of these, indeed, have more recently been shown to have real therapeutic value and are known to be effective in conditions such as diarrhea and some of the intestinal parasitic diseases. These discoveries were empiric: but then so were many of our own; and relative to cultural development, there is little basic difference between the application of their concoctions and the practice of carrying potatoes in the pocket as a cure for rheumatism. Nevertheless, their approach knew something of science: disease was held-as it is held in many fractals that the colonialists saw as primitive African communities today-to be the result of the direct activity of spirits, who had to be placated, yet the modern world now operates in similar fractal condition that if they had mastered, the world will not be in difficulty. Tribal mores were strong and the influence of the physical environment in the sense that we know it today was not considered.

The dawning of western medicine began gradually as exploration and settlement developed. Sporadic contributions had been made in the eighteenth century as a result of observations made by individual naval and military surgeons and missionary doctors, but these contributions were not appreciated fully at the time and their immediate influence was small. However, some classic records remain.� One of these was the account in 1803 by Thomas Winterbottom, Physician to the Colony of Sierra Leone from 1792 to 1796, of the Africans in Sierra Leone and 'the present state of medicine among them'. This is commonly claimed to contain the first English account of sleeping sickness.

In fact, that account was given by John Atkins, a naval surgeon, who practiced in West African waters and who met the disease on the Guinea Coast in 1721.' In his description of 'the sleepy Distemper in Negroes', in his book The Navy Surgeon [1734), he states:� 'Their sleeps are sound, and sense and feeling very little: for pulling, drubbing, or whipping will scarce stir up sense or power enough to move, and the moment you cease beating, the smart is forgot'.

To these somewhat Draconian diagnostic measures were added a schedule of treatment which sounds a little drastic to our ears, but was no doubt not without benefit to the patient:� 'bleeding in the jugular, quick purges, stematories, vesicatories, acupuncture, seton, fontanels, and Sudden Plunges in the Sea: the latter is most effectual when the distemper is new, and the patient is not yet attended with a drivling at mouth or nose'. It is the charlatan method of treatment that the colonialists used to make our colonial medical practitioners to be dependent on the prescription of their imported medicine to make our economy dependent on the occidental economic system.

Nevertheless, a sound basis had been established by educated naval surgeons who were concerned not only with the maladies prevailing in warm climates but with those incidents to getting there.� The navigators venturing to Africa and elsewhere owed much to such far-sighted pioneers as Gilbert Blane and James Lind.

A great deal of the early provision of medical facilities for Africans was owed to missionary enterprise.� The example of David Livingstone contributed largely to the establishment of medical work as a recognized part of missionary activity.� Others were soon to follow and medical missionary work rapidly expanded in West, East and South Africa through the efforts of various churches who increasingly provided training for their members and the establishment of hospitals, dispensaries and other medical facilities.

For example, John Abercrombie in 1841 founded the Edinburgh Missionary Society for training medical students for missionary work. Yet in 1849 it was estimated that there were only 40 medical missionaries in the whole world. In 1863, lay doctors were associated with the Holy Ghost Fathers in 'Zanzibar; and the Universities' Mission to Central Africa and the Church Missionary Society started medical missionary services in various parts of Africa.� The latter Society founded Livingstone College for instructing missionaries in the elements of practical medicine in 1893 and in 1897 founded a hospital in Uganda.� The White Fathers had started work in the regions of the great lakes in East Africa in 1878 and in� 1899 the White� Sisters instituted� health work there.

Within the British sphere of influence in Africa, it is not surprising that the first glimpses of activity should have been seen in the West African territories.� Sierra Leone was among the oldest of these. When a free settlement of Negro slaves from Nova Scotia was begun there in 1787, through the vision of the philanthropist Granville Sharp, it was almost wiped out by disease at the very beginning. Although conditions apparently improved, through the use of ordinary basic methods of hygiene, the improvement benefited largely the settlers and their families alone.� Health conditions throughout West Africa were bad; and yellow fever, malaria and other conditions took a toll so great that there was a constant struggle with disease, handicapped by a lack of knowledge. That remarkable woman Mary Kingsley in her West African Studies, published in 1899, 13 deplored prevailing apathy and noted that 'no trouble is taken to pull down the death-rate by Science'. Although the Africans who relied on their herbal preventive measures never knew this diseases effect. Africa had been protected from global pandemics by the Sahara Desert.

While expeditions and the various Chartered Companies had provided such medical assistance as they could, it was sparse and not easy to come by. Indeed even two years after� Sierra Leone� had� been handed� over to� the� Crown� in� 1808, a Commission� of Inquiry,� referring� to� the� medical� department,�� stated:� 'The� provisions� for� this� department,� in a recent parliamentary vote, were a first and second surgeon, an apothecary and his assistants;� and were these offices filled up in a suitable way they might have been sufficient to effect their purpose� but such is the proportion� of the salaries to the efficiency and ability required� in the officers, that� no competent� person could be found� to accept the first two posts'.

The early Administrations�� in Africa had at first mainly devoted the provision of medical services, through force of circumstances, to the needs of existing establishments. The wider extension of these to the African communities as a whole had to wait upon further knowledge, better communications, more staff and more money. The 'insalubrity' of the climate blamed by the earlier observers as the source of illnesses in Tropical Africa was a misnomer:� for the major enemy of progress was not the climate, but the mosquito; yellow fever, malaria, filariasis and diseases not then identified as arthropod-borne had dominated the scene and frustrated the efforts of pioneers to establish permanent health conditions.�

Malaria wrecked many expeditions and some of these are vividly described by Gelfand in his monograph Rivers of Death.� With the first proof of the role of a blood-sucking insect as a vector of parasites pathogenic to man, Manson in 1879 had started a movement-for it was no less-which was to influence the future of tropical medicine and hygiene for all time. As one of his biographers, Alcock,' wrote, Manson's discovery 'merely as a scientific achievement laid open a large new territory for investigation, started a flood of new ideas, and thus paved the way for fresh conquests over ignorance'. The encouragement and influence which Manson gave to Ronald Ross, culminating in his demonstration that mosquitoes were vectors of malaria parasites, is now familiar history:� but although Ross's discoveries were first made in India, his further application of this knowledge to parasitic disease profoundly affected the health of all tropical countries and Africa was one of the first to gain. In 1899, Ross visited Sierra Leone and not only identified the vector of human malaria there, but subsequently set out proposals for dealing with it. In 1901 he prepared a report on the main measures required to reform health conditions in West Africa. Later he was to visit Lagos in Nigeria and Accra in the (then) Gold Coast and other investigations were to follow. In 1909 that great pioneer of tropical hygiene, Sir William Simpson, visited various parts of West Africa to study the existing organization of the medical services, particularly from the public health aspect. His very full report showed that while curative medicine had made considerable strides as a result of newer knowledge, prevention of disease-especially�� as regards the great mass of indigenous people-had made little progress:� 'the conditions that have changed', he wrote, 'belong to the individual rather than to the locality'.

The appearance of Mary Kingsley's book and Ross's investigations took place at about a period when a great step was taken in the organization of medical services in Africa and elsewhere. A far-sighted Colonial Secretary, Mr. Joseph Chamberlain, on the advice of Manson, addressed the General Medical Council and the principal British Medical Schools in 1888 with the proposal that medical officers appointed to tropical territories should have a special knowledge of tropical diseases. Ten years later in a despatch to all Governors of Colonies he advised that a special school for training in tropical medicine should be set up and that this subject should be taught on a wider scale in the principal medical schools in the United Kingdom. The London School of Tropical Medicine was founded in 1899: but it was not, in fact, the first, for a similar school had been established in Liverpool, earlier in the same year, not by government initiative but by the enthusiasm of a great captain of industry, Mr. (later Sir) Robert Jones, whose interests in the West Coast of Africa were considerable. The pattern of the present organization of medical services in Africa may be said to have taken shape in the establishment of an amalgamated West African Medical Service in 1902. Similar groupings were to follow: The East African Medical Services were amalgamated in 1903, though they separated later, but again achieved some closer union. The eventual logical step was the establishment of a Colonial Medical Service with appointments made in London, but with their own local administrations yet with a similar structure which varied according to their local requirements.�

In East Africa, for example, although the pattern of development followed lines similar to those in West Africa, there were a number of differing local factors which required special approaches.� In East Africa generally there were eventually many Asian immigrants, and numerous European settlers in highland areas, and thus the racial distribution differed from that in West Africa. In Kenya, the medical department was first organized in 1905, when control of the country passed to the Colonial Office, although there had been a few medical officers in the days of the Chartered Company. In Uganda, there was a Government Hospital in Kampala in 1908, but Mulago Hospital, opened as a general hospital in 1922, was to become eventually the now magnificent teaching hospital for the medical school of the East African University College in Makerere. Uganda was indeed early in the field of training African medical personnel.� From an initial course of training in Mengo in 1917, there developed in time the medical school with full facilities for professional training which now exists. The ravages of sleeping sickness which plagued Uganda in the opening years of this century was a particular factor in stimulating a new attitude in the provision of health services for Africans. In some infected areas, as many as 200,000 persons died.

This resulted, among other awakenings, in a stimulus to the Royal Society to send commissions to study African sleeping sickness and one result of the heightened interest in this alarming disease was the foundation by the Colonial Office in 1908 of the Sleeping Sickness Bureau in London, formed to collect and distribute information on this disease. This organization was the forerunner of the Bureau of Hygiene and Tropical Diseases whose abstracting Bulletins are still a guiding light to current literature on tropical medicine and hygiene. The development of medicine and medical services in Tanganyika was a natural extension of the groundwork inherited from the former German East Africa. When the country became a Mandated Territory under British administration�� in 1923 medical services went ahead.� The history of their development has been admirably related by Clyde.� In Zanzibar, Nyasaland and the High Commission Territories of Basutoland, Bechuanaland and Swaziland, development took place slowly on the general pattern suited to their local conditions.

In South Africa, already with a long medical history, a Ministry of Public Health was established in 1919. Here, development of medical services which had been occurring steadily for more than two hundred years was naturally more sophisticated than that of its neighbours and it has progressed along western lines. The large factors of mining and of immigrant labour on a large scale from neighbouring countries posed, however, special problems of their own.

The medical problems of Southern Rhodesia were similar to those of the Union, though malaria was a greater problem.� Northern Rhodesia (now Zambia) has had problems of sleeping sickness and the additional health questions posed by the large amount of labour in its copper mines. In 1948, Southern Rhodesia acquired a Minister of Health and the Medical Department was subdivided into curative and preventive services.

While Egypt and the Sudan no longer fall within the scope of this survey, their past contributions to the development of medicine in African countries of the Commonwealth have been considerable.� A great deal of intensive work on tropical diseases, especially on schistosomiasis, has been carried out in these countries, much of it by Commonwealth�� workers in two world wars; and the contributions�� made by the Wellcome Tropical Research Laboratories in Khartoum, equipped by Henry Wellcome in 1902, and the training of Sudanese in the Kitchener School of Medicine founded in 1924 have been significant landmarks.�

The pioneer work of such great figures as Balfour and Chalmers is well known. It would not be practicable within the compass of a single lecture-and it would in any case, be extremely boring to the listener-to list the detailed forms which medical developments took in the different countries.� Basically, the ground structure was the same; a central administration, medical staff deployed on regional and district bases, with hospitals of varying grades, health centres, dispensaries and ancillary staff according to the needs and the resources of particular areas. In addition, there are general and specialized laboratories, and, in larger centres, research institutes, sleeping sickness organizations�� where these are required, mass campaigns against endemic diseases and-as in Nigeria-mobile units derived from these and now used as 'shock troops' for dealing with epidemics, surveillance and other activities.� Today in the independent�� countries, the pattern tends to be that of Ministries of Health, rather than of the former Medical Departments.

Most important� are the training centres, which vary from full-scale medical schools, such� as� those� in� Ibadan�� in� Nigeria,� Makerere� in� Uganda,� and� the� University� of Rhodesia,� to others training� more specifically various grades of medical auxiliaries medical assistants� with a broad� training� not up to graduate� status,� laboratory� technicians,� field� assistants� and� various� dispensers� and� 'Aides',�� all� with� a� degree� of knowledge sufficient to deal with the kind of problems� which might be encountered at their level in the field. The emphasis on training today is on prevention and many campaigns are frequently sponsored by W.H.O., after which not only are the local staff encouraged to maintain the work themselves, but where possible the machinery is integrated into the general public health services.

It must not be thought, however, that medicine in Africa has developed solely from the efforts of the territorial administrations.�� Reference has already been made to the great work carried out by the medical missions. In addition, the increase in the industrial, agricultural, commercial, mining and other forms of development brought with it many companies and other agencies. Several of these have their own medical staff, some of them highly organized. Not only, therefore, is occupational hygiene finding its place in the new Africa, but these agencies have much to contribute to health in general both alone and in association with governmental enterprise.

To discuss the prevailing diseases of the African countries in the Commonwealth would be a story in itself. In any case most of the diseases commonly called tropical are present there as elsewhere, and perhaps the only truly indigenous one is African trypanosomiasis.� It would not perhaps be out of place, however, to note that as the means of controlling these diseases improve and are extended, they will bring more into perspective the importance of the cosmopolitan diseases. These have always been there, less obtrusive perhaps because of the more specifically tropical conditions, but likely to be more so as the pattern of living changes.� Cerebrospinal meningitis has been constantly present and has caused many serious epidemics, especially in West Africa, during the century. Measles is a prominent killing disease of African children. Tuberculosis is a major problem and despite modern advances in treatment and prevention these measures are commonly restricted or modified by logistics and cost, though some notable advances have been made. Venereal disease is widespread.

Occupational disease is likely to become more prominent as development advances. The wide studies and knowledge of virus diseases have served to uncover many infections which were hitherto not identified.� For example, it is only in recent decades that the extent of poliomyelitis in Africa has been recognized.� Of special interest is the recognition of increasing numbers of infections caused by arboviruses, some indeed having been identified originally in Africa. Two of these are of special interest. Chikungunya virus was first isolated as a result of a study of a dengue-like outbreak in Tanganyika in 1952. Now it is a well-recognized member of the arbovirus group and its incidence has been shown far afield, as in its association with haemorrhagic and dengue-like fevers in such countries as India and Thailand.� O'Nyong-Nyong fever, also a dengue-like disease, was identified in Uganda in 1959. Of particular interest was a finding that it showed some interference with outbreaks of malaria and this phenomenon is being pursued.

A very topical subject, with an African history, is Burkitt's tumour, a lymphoma notably found in African children. It was given prominence by Burkitt in Uganda in the 1960s but has since been detected widely in many other countries, in various subjects and forms. Epidemiological studies showed a striking association between topographical, meteorological�� and�� other�� features�� and�� conditions�� favourable�� to mosquito�� breeding.� This suggested a possible arborvirus aetiology and vigorous studies are being pursued, not only in Africa, but in many virus research institutes in Europe and the United States, on this aspect of the subject. The implications of these studies in the investigation of a possible role of viruses in the aetiology of cancer are enormous; and although a number of viruses have been isolated from Burkitt's tumours, none in fact has so far been incriminated as being causative. �

What were the factors which influenced the course of medicine in Africa from the first gropings of the mid-nineteenth century to the vast developments in the twentieth? There were a number, at first sight unrelated, but to some degree overlapping and they weave between them an enlightening story of medico-social evolution.� The central point of all this was the African himself, with his soil, his animals, his tribal mores, a whole environment which was engaged in a constant struggle with two formidable foes-poverty and parasites. Although Afrca at the time never needed money for anything other than on market days because, trade by barter for every day requirements was normal.

Basically, there were certain operating factors. There was the more enlightened attitude of the Colonial Administrations. There was the co-operation of missionary, governmental and non-governmental agencies in the joint application of knowledge and resources. There was the opening up of trade, industry, commerce and communications and with it the provision of men, money and momentum to apply practical measures.� There was a vast and rapid increase in scientific knowledge and research with the discovery of new drugs, antibiotics, insecticides and the application of public health engineering. There was the development of W.H.O. with its help and guidance. There was the effect of wars, especially two world wars, which influenced the application of practical medical measures, both for better and for worse.� There was the impact of migration and urbanization, with all the consequent results of the breaking of tribal and family ties and the exposure to tuberculosis, venereal and other diseases of overcrowding.� There was the achievement one by one, of national independence by African countries and of a new status and pattern of living. Above all there were two outstanding factors, the recognition of the over-riding importance of preventive rather than solely curative medicine and the education, particularly�� the health education, of the peoples themselves.

The South African war had produced a striking object lesson in the need for preventive medicine in the field. For some 7,000 men killed in action, for example, there were 57,000 affected by typhoid.� The First World War broke out with a knowledge of tropical medicine already established on a sound basis:� but there was still much to learn and a great stimulus was provided by the urgent necessity for protecting troops against disease in the field; and tropical medicine emerged enriched by its experience and triumphant�� in a newer knowledge which was soon applied to the problems of peace.� The Second World War found the African countries better equipped for the formidable tasks which faced them; and while the civil medical departments were greatly depleted, they were constantly learning the new lessons which the various campaigns in different regions of Africa and elsewhere had taught them. The introduction of many synthetic antimalarials, drugs for use against sleeping sickness, schistosomiasis and other helminthic diseases and the use of sulphones for leprosy played a notable part.� The development of D.D.T. and related insecticides, and later of organophosphorus and other types of insecticides, provided new weapons against the vectors of disease.� Improved molluscicides strengthened the control of schistosomiasis.� The development of a safe and effective yellow fever vaccine has had so striking an effect that yellow fever-once the scourge of Africa-is now a comparative�� rarity there.��

Antibiotics, curative�� in so many diseases, reduced the incidence of yaws to a manageable proportion in many areas. But these 'wonder�� drugs'�� and pesticides were soon to show their limitations. Resistance of parasites and vectors developed in a number of areas, but fortunately many of these drugs and pesticides were replaced by newer discoveries. The application of the newer measures was, furthermore, beset by formidable difficulties, logistic, sociological and financial, so that the general eradication of insect-borne disease in rural areas of Africa is not yet in sight.

Meanwhile, the human element, as one might expect, dominated much of the scene.� Industrialization�� and urbanization, already referred to, played an increasing part. The rapid development of the great mining areas in Kimberley and the Rand had brought workers from many parts of Africa. Other developments in West and East Africa brought their own problems.� The copper mines in Zambia needed measures to combat occupational disease. Fortunately, where mining activities were adequately controlled, such organizations�� as the Silicosis Bureau and the arrangements for regular examination of labourers dealt adequately with such occupational diseases and their consequences and they have been reduced to appreciably low proportions.

Soon after World War II the drive for independence in the African countries took on a new momentum.� When these countries achieved their independence one by one, they were left with a great legacy of highly efficient medical and public health organization, built on the western pattern and with the machinery ready to take over. But machinery is not enough:� once again the human element is paramount.� All those in the medical services, expatriate and indigenous, had been largely trained in the ways of western medicine: but few had been trained to the quite specific needs of medicine in Africa, their priorities and the best ways in which to apply them. It became apparent and much recent writing has supported this-that much training for medicine in Africa should be carried out in Africa and that until education is much more widespread the number of conventionally trained doctors cannot hope to deal single handed with the vast health problems of rural Africa. The standards of medical qualification must not be reduced:� but the emphasis needs to be put on the specific problems to be faced in rural Africa.� Much groundwork remains to be done in health education, by 'selling' to the people the needs for health and above all to show them how to apply the basic measures themselves. Much of this can best be done in the field through the influence of Africans themselves, who can translate the concepts of modern science in terms which their people can understand; and this should be encouraged throughout the social scale from the Medical Officer of Health to the Village Headman. Fortunately, in many countries facilities for training are being developed in increasing numbers.�

Meanwhile, the goal must be the eventual application of full scientific measures, the increasing education of fully qualified doctors, adapted where necessary to local needs, but with the use of every discipline which modem science has to offer: and this implies not just medical science but sociology, psychology and all those approaches necessary to meet in a humanitarian way the cultural needs of the people concerned.� The first priority is not for expensive equipment: it is for enlightened doctors. Fortunately, research is not lacking and indeed in many parts of Africa has reached a high state of maturity.� One can but look, for example, at such agencies originally formed, as the East and West African Councils for Medical Research, the East African Medical Survey, the East African Tsetse and Trypanosomiasis Research and Reclamation Organization, the Viral Research Institutes in Entebbe and Lagos, the West African Institute for Trypanosomiasis Research and numerous other institutions, committees and research laboratories either former or existing. Many pilot schemes on the control of diseases in various parts of Africa have pointed the way to wider measures.

The many developments medicine in Africa have achieved some remarkable results and indeed some of the projects undertaken are themselves classics in the history of tropical health.� A few examples may give some indication of the compass of some of these undertakings. One was the introduction of sleeping sickness settlements in East Africa associated so closely with the name of George MacLean, though it eventually involved a tremendous combined operation of many disciplines and agencies. The basic concept was that in bush country infested with tsetse flies in Tanganyika where Trypanosoma rhodesiense infection occurred there were some natural clearings unattractive to the fly and with relatively small populations.�

The purpose of the scheme was to enlarge those areas and to transfer to those new clearings people from villages in bush areas which were infested with tsetse flies. This meant a complete change of their way of life and the development of a new environment which would embrace all the necessities for the growth of self-supporting communities. This was resettlement on a vast scale, with provision of water supplies, dwellings, farm animals and the development of crops. Whole communities were thus separated from tsetse flies and hence from infection with sleeping sickness. A similar system was also applied in country of a different kind such as that adjacent to rivers and lakes where T. gambiense was the parasite, and various methods of approach were carried out in other parts of East and West Africa.

In West Africa a system of selective clearing was introduced, and it was in Nigeria that a classical undertaking was made in resettlement and formation of thriving communities in an area heavily infected with T. gambiense sleeping sickness. This was in the Anchau area where a scheme was undertaken to control the vector flies in a corridor of some 70 x 10 miles.t" This ultimately resulted in the disappearance of trypanosomiasis�� in man and animals and the people themselves maintained the area which they had cleared.

Both of these enterprises called for closely planned and executed operations not only by the medical department, but by administrative, veterinary and agricultural departments. This underlines what cannot be repeated too often regarding public health advances in Africa, namely that it is not just a departmental problem, but one which involves close consultation and activity between all the agencies and disciplines which contribute to the full development of the African in his environment.

Brief reference may be made to two other projects which illustrate the need to foresee the implications for community health in the undertaking of large-scale industrial schemes in Africa and the hazards of man-made obstacles to health. The Volta River hydro-electric scheme in Ghana posed many problems, not the least of which was the settlement and protection of people from disease resulting from flood. Measures had to be taken to deal with such conditions as malaria, ankylostomiasis, and schistosomiasis, and this involved careful planning and execution by the health authorities. The construction of the Kariba Dam in the Zambesi Valley raised comparable problems and a comprehensive medical organization was developed to deal with them. Detailed accounts of these approaches have been written and would repay reading.

It is clear from the foregoing that clinical medicine, while it must always have its proper compassionate place in relieving individual suffering in Africa, should develop hand in hand with increasing preventive efforts. It is curious that in western countries the greatest advances in therapeutics have occurred in the last half century, while preventive medicine was already taking shape in the Victorian era. In tropical Africa the position was, in a sense, reversed.� The first gropings after the control of tropical diseases were based on the use of such drugs and empiric treatments as were available, but the concept of prevention had to await the newer knowledge of transmission of disease and of its control. It is true that the prophylactic use of some of the newer drugs may be the only means, by reason of limited communications, men and money, for mass prevention of a number of diseases in rural areas of Africa.� But in others wider preventive measures, whether against diseases, vectors or ignorance, are the means in which increasing hope must be placed in the future.

In the development of medicine in Africa from scientific ignorance to organized community health the groundwork is sound and the pattern clear and flexible enough to be adapted to various local needs: yet it must be repeated that however well organized the practical measures, the future must depend on increasing education of the people themselves. The problems are basically African problems and their solutions must ultimately rest with trained Africans at increasing levels of general, health and medical education.� For some time to come many developing countries will need expert outside help and guidance in solving their medical problems.� Such is already available through links with some British universities and other institutions who second staff to the needy countries, and by fellowships and other forms of aid enabling experts to spend periods in some of the former British African Territories to help in ad hoc projects or in an advisory capacity. In time, the Africans will take over completely themselves; but whatever form their medical facilities may take, the objectives will be the same-to pursue war on what President Nyerere of Tanzania succinctly described as 'poverty, ignorance and disease?� so that the peoples of Africa may be capable of leading full and healthy lives, free from the hazards which decimated their forefathers and many of those, too, who went to Africa to help them. To this objective Commonwealth Medicine has been proud to contribute in the past and is proud to continue to contribute�� in the interim in that tradition so well summarized in the motto of the Royal Society of Tropical Medicine and Hygiene, Zonae torridae tutamen.

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1.2.1 Mesopotamian ^c

Medicine in Assyria and Babylonia was influenced by demonology and magical practices. Surprisingly accurate terra-cotta models of the liver, then considered the seat of the soul, indicate the importance attached to the study of that organ in determining the intentions of the gods. Dreams also were studied to learn the gods' intentions.

While magic played a role in healing, surviving cuneiform tablets indicate a surprisingly empirical approach to some diseases. The tablets present an extensive series of medical case histories, indicating a large number of medical remedies were used in Mesopotamia, including more than 500 drugs made from plants, trees, roots, seeds, and minerals. Emollient enemas were given to reduce inflammation; massage was performed to ease gastric pain; the need for rest and quiet was stressed for some diseases; and some attention was paid to diet. Water was regarded as particularly important, since it was the sacred element of the god Ea, the chief among the numerous healing gods. The serpent Sachan was also venerated as a medical deity.

1.2.2 Israeli/ Palestinian ^c

Hebrew medicine was mostly influenced by contact with Mesopotamian medicine during the Assyrian and Babylonian captivities. Disease was considered evidence of the wrath of God. The priesthood acquired the responsibility for compiling hygienic regulations, and the status of the midwife as an assistant in childbirth was clearly defined. Although the Old Testament contains a few references to diseases caused by the intrusion of spirits, the tone of biblical medicine is modern in its marked emphasis on preventing disease. The Book of Leviticus includes precise instructions on such varied subjects as feminine hygiene, segregation of the sick, and cleaning of materials capable of harboring and transmitting disease. Although circumcision, the surgical removal of the foreskin on the male�s penis, is the only surgical procedure clearly described in the Bible, common medical practices include wounds dressed with oil, wine, and balsam. The leprosy so frequently mentioned in the Bible is now believed to have embraced many skin diseases, including psoriasis.

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1.2.2.1 Thalassotherapy ^w

Thalassotherapy (from the Greek word thalassa, meaning "sea") is the use of seawater as a form of therapy. It also includes the systematic use of sea products and shore climate. There is no scientific evidence that thalassotherapy is effective.

Some claims are made that thalassotherapy was developed in seaside towns in Brittany, France during the 19th century. A particularly prominent practitioner from this era was Dr. Richard Russell, whose efforts have been credited with playing a role in the populist "sea side mania of the second half of the eighteenth century", although broader social movements were also at play. In P�voa de Varzim, Portugal, an area believed to have high concentrations of iodine due to kelp forests, and subject to sea fog, the practice is in historical records since 1725 and was started by Benedictine monks; it expanded to farmers shortly after. In the 19th century, heated saltwater public baths opened and became especially popular with higher classes.

Others claim that the practice of thalassotherapy is older: "The origins of thermal baths and related treatments can be traced back to remote antiquity. Romans were firm believers in the virtues of thermalism and thalassotherapy.

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1.2.3 Chinese Medicine ^m

The earliest Chinese medicine, in common with most other ancient civilizations, assumed disease and illness were caused by the gods or by demons. The correct remedies for illness involved ritual exorcisms and appeals to the Gods.

A more naturalistic explanation of illness developed with the belief in Yin and Yang. The Yin and Yang principles were considered to control everything and their interaction controlled the functioning of the human body. Yin was feminine, soft, cold, moist, receptive, dark, and associated with water, while Yang was masculine, dry, hot, creative, bright, and associated with fire. Human health depended on a balance between Yin and Yang. Further factors effecting disease were wind, rain, twilight and brightness of day so there was a total of six disease making influences. Any of these six influences could upset the balance of Qi, which was a vital spirit similar to breath or air, which existed throughout the human body.

Chinese knowledge of anatomy was very limited due to a strict prohibition on the dissection of the human body. Chinese belief concerning the inner organs was largely erroneous. They believed there were five �firm� organs that acted as receiving organs and lay opposite five �hollow� organs who served the purpose of evacuation. The firm organs were the heart, spleen, lungs, liver and kidneys. The heart was considered to be the place of wisdom and judgment while the liver and the lungs were associated with the soul. The male�s right kidney was seen as the source of sperm and its connection with the passage of urine was not understood. The hollow organs were the bladder, gall bladder, colon, small intestine and the stomach.

Chinese doctors attempted to make a diagnosis by studying the state of the pulse. This practice known as sphygmology involved attempting to recognize some very subtle variations in the pulse. There were considered to be 51 different varieties of pulse which were to be taken in 11 different areas of the body. Chinese doctors were attempting to obtain far more information from the pulse, than it could possibly provide.

Acupuncture, aimed to restore the balance of Yin and Yang, and involved inserting needles into particular parts of the body. There were 388 areas of the body into which the needles could be inserted and they needed to be inserted at the correct time, based upon the weather, the time of day and the phases of the moon. The needles were left in anything from five to fifteen minutes. Acupuncture does appear to be effective for pain relief as the needles seem to make the body produce endorphins, the body�s own natural painkillers. Claims have been made that acupuncture can cure many diseases including muscle, bone, respiratory and digestive disorders.� A further Chinese treatment was Moxa which involved inflicting a slight burn on the skin. It was considered to be a treatment for a vast range of complaints such as diarrhoea, abdominal pains, anaemia, vertigo, nose bleeding, gout, toothaches and headaches.

1.2.3.1 Traditional Chinese Medicine - an Overview ^p

Background: Traditional Chinese medicine, which is the basis of the Chinese culture heritage, has a long history of 5000 years and it has significantly contributed to the survival of their nation and its prosperity. Over time, various theories have been systematized and developed in order to maintain and improve the health of the Chinese population. Objective: The objectives of the paper are: a) to present the historical development of traditional Chinese medicine, b) to explain the basic principles on which traditional Chinese medicine is based on and c) the basic methods of treatment and most common herbal remedies used in traditional Chinese medicine. Methods: The paper is of descriptive nature, and numerous and informative literature was used for its writing, mainly texts from books and articles published in indexed journals retrieved from the world online databases. Results and Discussion: The first records of traditional Chinese medicine date back to the Huang Di period, and the first record is from a book called NeiJing and it represents the theoretical foundation of traditional Chinese medicine.

Over thousands of years, progress has been made in this area and numerous dynasties have invested resources and knowledge to maintain and develop it. The Han Dynasty and the Tang Dynasty produced some of the best physicians and connoisseurs of traditional medicine, and the Ming Dynasty contributed perhaps most of all. Immediately after the end of the Opium Wars, the Western world evaluated traditional Chinese medicine as a feudal and scientifically unproven method. Since then, the Chinese authorities have focused on preserving the integrity of their traditional medicine, and at the end of the 20th century, the World Health Organization accepted traditional Chinese medicine as a scientifically based method of treatment and gave it the name Complementary Medicine. The theory of Chinese traditional medicine is based on several principles: qi theory, the concept of yin-yang, the theory of the five elements, the concept of zang-fu organs, and the theory of meridians and parallels. Conclusion: Traditional Chinese medicine has made a significant contribution to the development of modern medicine during its long history, as well as one of its most difficult and complicated aspects the acupuncture, which requires extensive knowledge of all concepts of traditional Chinese medicine and perfect precision.

1. BACKGROUND

History is full of mythology in the case of the Three Kings of Heaven who are revered as the founders of Chinese civilization. Fu Hsi, for who is believed to have ruled 2000 years before Christ, is the legendary founder of the first Chinese dynasty. His most important inventions included writing, painting, music, original mythical trigrams, and the yin-yang concept. Both the Ching or Rule of Change that is respected as one of the oldest Chinese books has been attributed to Fu Hsi.

The invention of key agricultural and farming techniques has been attributed to Shen Nung, another Heavenly Emperor. When the emperor, who is also known as the Divine Peasant, saw that his people were suffering from disease and poisoning he taught them to sow five kinds of grain and he personally studied thousands of plants so that people know which are medicinal and which are poisonous. In his experiments with poisons and antidotes, Shen Nung tried as many as seventy different poisons in one day. After collecting many drugs in the first major study of herbal medicine and after presenting a magnificent example of selfless devotion to medical research, Shen Nung died after a failed experiment. During a century of rule, Huang Ti, the last of the three legendary Heavenly Emperors, gave his people a wheel, a magnet, an observatory, a calendar, the art of measuring heart rate, and the Huang-ti Nei Ching (Yellow Emperor�s Canon of Internal Medicine) �a text that inspired and guided Chinese medical thought over 2500 years. Like many ancient texts, the Nei Ching has been corrupted over the centuries with additions, cutouts, and typographical errors. Scholars agree that the existing text is very old, perhaps even dating back to the first century BC, but the time of its compilation is polemical.

Most historians believe that the existing text was composed at the beginning of the T�ang dynasty (618- 907). Other medical texts have once overshadowed it but most of the classics of Chinese medicine can be considered an interpretation, commentary, and supplement to the Yellow Emperor�s Code (CANON). Although the Inner Canon is appraised as one of the oldest and most influential texts of classical Chinese medicine, studies of medical manuscripts that were buried with their owners, probably during the second century BC, and found in Mawangda, Hunan in the 1970s provided a new insight into early Chinese medical thought. As the newly discovered texts are analyzed, scholars are beginning to understand the philosophical foundations of Chinese medicine and the ways in which educated physicians from the fourth to the first century BC managed to distance themselves from shamans and other folk healers. Physicians were apparently still researching approaches in psychology, pathology, and therapy that differed from those found in the Inner Canon (text). Therapists in older texts included medical drugs, exorcism, magical and religious techniques, and surgical procedures, but acupuncture, the main therapeutic technique in the Inner Canon, is not described in the Mawangdui manuscripts.

2. OBJECTIVE

The objectives of the paper are: a) to present the historical development of traditional Chinese medicine, b) to explain the basic principles on which traditional Chinese medicine is based on and c) the basic methods of treatment and most common herbal remedies used in traditional Chinese medicine.

3. METHODS

To write this paper, we used the scientific literature from articles that are stored in scientific databases and available by the Internet, and represent a reliable source.

Books stored in libraries in the Sarajevo Canton were also used as a source for writing the article, most of which were found in the National and University Library in Sarajevo.

Among them are books: Liu Z, Liu L. Essentials of Chinese medicine. Vol. 1. Springer. 2009; Lloyd J. U. Origin and history of all the pharmacopeial vegetable drugs, chemicals and preparations with bibliography. Read Books; 2008;

Gurley B, Wang P, Gardner S. Ephedrine-type alkaloid content of nutritional supplements containing Ephedra sinica (Ma-huang) as determined by high performance liquid chromatography. J Pharm Sci 1998; 87: 1547-1553. Used articles are quite recent and have been published in indexed journals, which means that their content is verified and reliable. In order to write a part of the paper on medicinal plants that traditionally originate from China, these books were used: Kovačević N., entitled �Fundamentals of Pharmacognosy� and the book �History of Medicine� by Magner LN. which is stored in the library of pharmaceutical company Bosnalijek Sarajevo. The book is of high quality and it offers a variety of content on the development of medicine and pharmacy over their long history.

This paper also contains numerous illustrations that complement the quality presentation of Traditional Chinese Medicine and their sources are cited in the legends below the figures (1-22).

4. RESULTS

The history of traditional Chinese medicine

The first records on Traditional Chinese Medicine (TCM) date back to 5000 years ago. The TCM encompasses Han medicine, as well as the theories and practices of various national minorities from China such as Miao, Dai, Mongols and Tibetans. The first records of TCM appear from the period 2698-2598 BC, during the era of Huangdi or the Yellow Emperor. However, the duties and responsibilities of physicians were defined only later, in 1122

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Figure 1. Bian Que�the oldest known physician from the area of today�s China and author of the Bian Que Neijing book dedicated to traditional Chinese medicine Available at: https://upload.wikimedia.org/wikipedia/commons/e/e0/Chinese_woodcut%2C_Famous_medical_figures%3B_Portrait_of_Bian_Que_Wellcome_L0039317.jpg.

Accessed: March 9, 2017.

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Figure 2. Paragraph from The Neijing, first part (Su Wen). Available at: https://en.wikipedia.org/w/index.php?title=File:The_Su_Wen_of_the_Huangdi_Neijing.djvu&page=3

Accessed: March 9, 2017.

BC, during the Zhou dynasty. At the time, every large estate had its own physician, and it was characteristic that physicians were paid when the householders were healthy, not when they would get ill. Thus, the primary concern of physicians was maintaining health and preventing disease, not treatment. TCM is the oldest continuously practiced, scientific medical system in the world. It certainly should not be classified as a term of folk medicine, nor quackery, because TCM is a complex and precise health care system created from the efforts of great Chinese minds to understand the secrets of the functioning of the human body (3). In its beginnings, TCM was a practical and effective art based on observations and experience with the application of philosophical principles such as Yin and Yang or wu-xing (the theory of the five elements).

One of the oldest physicians is Bian Que (Figure 1) or Qin Yueren of Hebei Province who lived in 500 BC. He was known as an excellent diagnostician with excellent pulse examination and acupuncture therapy skills. According to historical records, he is the author of the Bian Que Neijing book used during the Han Dynasty. Unfortunately, the book wasn�t preserved.

However, the publication of The Neijing (Canon of Internal Medicine of the Yellow Emperor) is the most significant book on TCM, which established the theoretical foundations of the medical system itself and philosophical theory. The writing of this book took hundreds of years, all the way from 770 to 221 BC. Astronomical and geographical observations, as well as theories about the existence of the human being, medicine, science, culture and philosophy can be found in the book. The book consists of two parts: Su Wen and Ling Shu. The first part of the book deals with the general principles of health and standard methods of diagnosis and treatment, and the second part is more specialist-oriented on the art of acupuncture and moxibustion (Figure 2).

The Han dynasty (206 BC to 220 AD) is considered one of the most important dynasties for the development of TCM and was marked by physicians such as Zhang Zhongjing and Hua Tuo.

Hua Tuo (Figure 3) was born in Anhui Province and is one of the most famous physicians of ancient China and one of the first known surgeons in China. Hua Tuo is known for being the first to invent anesthesia and deepen his knowledge of human anatomy. Practicing acupuncture and herbal remedies, he used simple methods using a small number of acupuncture points and prepared herbal remedies with simple herbal formulas. He was a practitioner of Qi Gong and invented the theory of five animals that is still used today (tiger, deer, bear, monkey and crane).

Even as a child, Hua Tuo lost his father and had to find a job. The fate was such that he was employed in a local herbal pharmacy. While working there, he carefully observed the practice of the physicians at the time. At a time when Hua Tuo was growing up, there was turbulent political turmoil and constant fighting. He was not a member of the army or an elite citizen, but he was spending time with the poor and dedicated his life to helping them, so he was also known as the �folk physician�. He soon became very famous, but despite the offer to become the king�s personal physician, he refused the offer. Hua Tuo was known that if the cause of the disease could not be removed with acupuncture or herbs, the only solution was to surgically remove the cause.

It is documented that Hua Tuo used the Figure 2. Paragraph from The Neijing, first part (Su Wen). Available at: https://en.wikipedia.org/w/index.php?title=File:The_Su_Wen_of_the_Huangdi_Neijing.djvu&page=3 Accessed: March 9, 2017.

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Figure 3. Hua Tuo and illustration of performing a surgery on a patient.

Available at: http://www.acupuncturetoday.com/mpacms/at/article.php?id=31781.

Accessed: March 11, 2017.

so-called Ma Fei San herbal formula in patients which had the effects of anesthesia and then performed surgery. One of the problems Hua Tuo noticed was that there were always a lot of sick people, more than he could cure. Therefore, he devised the Wu Qin Xi theory (the theory of five animals) which basically provided instructions on physical exercises, and which imitated the movements of a tiger, deer, monkey, bear, and crane. Unfortunately, as with most geniuses and influential historical figures, Hua Tuo ended his life in prison with the death penalty. Cao Cao, the ruler of the Wei kingdom, had severe headaches, presumably a migraine, which Hua Tuo first cured with simple acupuncture. However, Hua Tuo refused to stay in the castle and returned to his sick wife and people. Not long after, Cao Cao brought him back to his court and forbade him to leave it. The problem was that it was no longer possible to cure migraines with herbs or acupuncture, so Hua Tuo suggested surgery and surgical removal of the cause. Cao Cao considered it an attempted murder and sentenced him to death. During his captivity, he transferred all his knowledge to paper, but the guards did not want to preserve his works, so it was all lost along with him.

On the other hand, Zhang Zhongjing (Figure 4) is the most famous physician of all time in China and is considered a holy figure in medicine, something like Hippocrates in Western medicine. He wrote a work called Shang Han Za Bing Lun (treatment of febrile illnesses and various diseases) which contained over 100 effective formulas that are still used today. Zhang introduced such a system that the treatment was carried out on the basis of the differentiation of the syndrome in the patients.

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Figure 4. Zhang Zhongjing � Chinese ancient doctor who is considered the most important physician from the ancient era (150 � 219 AD). Available at:

https://www.britannica.com/biography/Zhang-Zhongjing.

Accessed: March 11, 2017.

Unfortunately, due to various political turmoil and numerous battles, very little historical data about his life has been preserved.

Not long after, during the Jin-Yuan dynasty, the theories of TCM were further developed and advanced with the establishment of four branches of TCM. Liu Wansu found the so-called cooling school where the basic principle was treatment with herbs that cause a feeling of cooling in patients. Zhang Zhihe found a school of �attack� based on the use of diaphoretics, emetics and purgatives to attack pathogens and expel them from the body. Li Dongyuan advocated a theory that focused on all diseases being caused by damage to the stomach/spleen, most commonly caused by uncoordinated eating, drinking, work, or seven excessive emotions. Ultimately, Zhu Danxi was a devotee of preparing various tonics, especially those that cleansed the kidneys and liver. He believed that people get sick because they enjoy the pleasures and immoral things in this world too much which would upset the balance of yin.

The greatest success and development of TCM was experienced during the Ming Dynasty (1368-1644), culminating in the publication of the Compendium of Material Medica (Figure 5) by Li Shizhen. Li Shizhen dedicated himself to gathering the most important and credible medical experiences over 30 years and singled out a total of 1,094 herbal medicines, 443 animal medicines and 354 mineral medicines. For each drug, an adequate name, source, form and medical history were prescribed, as well as the manner in which it was collected, prepared, stored and dosed.

The basics of Traditional Chinese Medicine Modern TCM theory has emerged from the naturalistic philosophies of ancient China with special influences of experiences that have accumulated through generations and generations. TCM may seem outdated and charlatan today, but it is a complete, integrated method of interpreting human physiology and pathological changes in the body. The most important concepts of TCM are qi, yinyang and the theory of the five elements (wuxing). Theoretical concepts of specific TCM include the doctrine of zheng ti guang nian, the concepts of viscera and compassion (zangfu xue shuo), channels and networks (jingluo), bodily substances (qi, blood, essence and body fluids qi xue jing jinye) and pathological agents (bing yin). All these theories, together with the methodologies of the four methods (si zhen) and basic discrimination (bian zheng) form the theoretical basis of TCM. Each of the therapeutic methods of TCM, such as acupuncture and moxibustion (zhenjiu), Chinese herbology (zhongyao fang), and Chinese therapeutic massage (zhongyi tuina) are based on the above mentioned theoretical foundations.

Concept of Qi theory The basic concept of qi theory is that qi is the basic substance from which the entire universe is built and that all objects in the universe are born by the transformation of qi. Ancient philosophers argued that qi could exist in two states: dispersion and condensation, and these two states�

Figure 5. Fragment from the book Compendium of Material Medica which was written by Li Shizhen. Available at: https://commons.wikimedia.org/wiki/

File: Compendium_of_Materia_Medica_2.jpg.

Accessed: March 12, 2017.

of qi determine two modes of perception in human: one having a form and one without a form. When qi is in a state of dispersion then we speak about a state without form. It is a state that does not occupy any limited space and does not possess a definite and stable form. In contrast, when it is in a state of condensation then it possesses its own form or shape. In this state it can occupy a limited space and possess the final and stable form of any of the objects. The most interesting thing is that qi can pass from one state to another to infinity. From a medical point of view, qi is a substance that permeates the human body and they together form one whole. Chi is considered the basic substance of the human body and once it is in a dispersed state�the body dies. Something in line with the yin-yang theory, which will be explained later, there are two types of qi�Yang qi and Yin qi. Yang qi is described as lightness, purity, activity and warmth, while Yin qi is just the opposite. Therefore, the celestial vault is composed of Yang Chi, while the earth is formed of Yin Chi, and their combination and unification created all living and non-living matter on Earth, including humans, animals and plants. The fact that every living matter in the world is different from each other is the result of a different combination of the two types of qi.

According to the qi concept, there are two types of change in the universe. One type of change is quantitative and it is difficult to notice and occurs gradually and is only measured quantitatively, not qualitatively. The second change is qualitative and it occurs when the quantitative change has reached its maximum and then there is a transmutation of one thing into another. All of this can be related to TCM because it combines the effects of seasonal changes on the vital activities of the human body.

In addition, TCM attaches great importance to the diversity and specificity of geographical locations and orientations, which is in line with one of the most difficult relationships to explain, and that is the relationship between space and time and the principles of dynamic change in the universe.

The concept of Yin-Yang According to ancient Chinese philosophy, yin and yang represent two essentially opposite categories. At first, their understanding was simple, describing the turning of the face or back to sunlight. It was later introduced into the theory that yin and yang refer to almost all imaginable opposites, such as time, position, side of the world, state, etc. Ancient Chinese philosophers wisely observed that for every phenomenon there are two opposing aspects with each other. Thus, yang is represented by phenomena such as speech, active state, external, upper, warm, light, while yin is associated with opposite phenomena: silence, inactive state, internal, lower, cold, dark (Figure 6).

Yin and yang theory have four fundamental foundations, known as the four relations of yin yang:

� opposition,

� interdependence and coherence,

� intermediate consumption and support and

� intertransformation.

As already stated, yin yang theory is used to describe a universal qualitative standard. One of the basic aspects is certainly yin which exists as the very opposite of yang. Heaven and earth, sun and moon, night and day, inside and outside are manifestations of the dual intrinsics of the universe.

In the context of medicine, the upper body is yang, and it is related to the lower body which is yin. However, the front of the body is yin, while the back of the body is yang. Likewise, the medial part of the body is yin and the lateral part is yang. Most importantly, the inner part of the body represents yin, while the outer part is yang. Inside the yin, or inside the body, there are so-called zang organs (called viscera) and which are considered solid and belong to yin, while fu organs belong to yang. Diseases that manifest with symptoms such as fever or excessive metabolic activity belong to yang, while the opposite is yin. The fast and short pulse is yang, while the slow and long pulse is yin (Table 1).

Since yin and yang form one whole, they are also interdependent. The whole is defined by the existence of two opposites such as fire and water, hot and cold, interior and exterior. In the field of medicine this can be seen in the relationship of structure and function. The structure is in any case yin, while the function is yang. A sufficient amount of the substance (structure) in the form of, for example, body fluid, healthy tissue, etc., enables the normal function of the organism. Only when the process is functional can adequate recovery occur and such a balance between structure and function is the basis of healthy��

Table 1. Basics of yin yang opposites that are used in Traditional Chinese Medicine

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Figure 7. Five primary elements in Traditional Chinese Medicine and their connection.

Available at: http://www.springer.com/cda/content/document/cda_downloaddocument/9781461452744-c1.pdf?SGWID=0-0-45-1415302-p174674052.

Accessed: March 18, 2017.

functional activity. Interaction and connection are another aspect of yin yang. There is no phenomenon, event or situation that can be described as complete yin or complete yang. Every phenomenon in the university has yin and yang aspects, depending on the angle from which the situation is viewed. For example, day is considered yang when compared to night, but the first hours of the day (before noon) are yang compared to the hours after noon, which are yin.

So, in China it is said that morning is yang with yang, and afternoon is yin with yang. Every phenomenon can be brought to infinity in this manner.

Inter-consumption and support are also an integral part of yin yang. Growth, development and progress in one aspect means setback in another aspect. Under normal circumstances, consumption/support occurs within certain limits. In the context of physiology, this phenomenon may be associated with homeostasis. Exceeding these limits results in organ dysfunction and disease. If yang disorder occurs, e.g., increased metabolic activity, yin resources are consumed. Conversely, aging (yin) can lead to a drastic reduction in bodily functions (yang). In pathological terms, all diseases have four causes: yang or yin excess, yang or yin deficiency.

Another characteristic is intertransformation. From a medical point of view, this can happen in two ways: harmoniously, as a natural course of development, aging and death, or inconsistently due to drastic changes in the environment or internal imbalance. Thus, Chinese physicians claimed that when yin is extremely pronounced, at some point it will turn into yang. Such a case can be seen when high fever (yang disorder) leads to shock and the onset of hypothermia and loss of consciousness, which in turn are yin symptoms.

Theory of five elements (wuxing)

Each of the categories/elements represents a category of certain functions and qualities. The wood is associated with spring, flowering, growth, awakening, morning, childhood, anger and wind. Fire, on the other hand, is associated with summer and represents a state of maximum activity, accelerated growth, noon, excessive happiness and an open flame. The earth is associated with the end of summer, i.e. the transition to autumn. It represents balance and equilibrium, early afternoon, refreshment, anxiety and moisture. The metal is associated with autumn, reduced functions, movement towards crystallization, clarity, sadness and no precipitation. As for water, it is related to winter, state of decay, accumulation, rest, night and possible development of new potential, concentration of will and fear and cold. This categorization can be applied in China to colors, sounds, smells, tastes, emotions, animals, planets, and almost everything in the universe (Table 2).

All five elements are interconnected by fixed connections.

There are two connections between them, and they are sheng and ke connections. Both connections are natural and necessary. Sheng is an incentive, and ke is a control.

Sheng is a connection where one element gives rise to another. Thus, for example, wood stimulates fire, and fire stimulates earth, earth stimulates metal and metal stimulates water, while water stimulates wood. The circle is

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Table 2. Relationships of five elements and their corresponding states also known as the mother-son relationship, with the stimulus phase acting as the mother for the next. There is also a circle through which the elements control each other, so wood controls the earth, earth controls water, water fires, fire metal and metal controls wood.

The five-element theory is directly related to the zang and fu viscera, and to the acupuncture channels that are classified in this manner. The theory of the five elements is also used to interpret the physiology and pathology of the human body and its connection with the natural environment.

Thus, the five-element theory is related to etiology, diagnosis, treatment, and prognosis.

The most important statement of the five-element theory is related to the zang organs: the tree represents the liver, which regulates the free flow of qi; fire represents the heart which provides heat to the whole body; the earth represents the spleen which is in charge of transporting and transforming food; metal represents the lungs that allow the relief of qi; water represents the kidneys that are in charge of storing the essence and regulating body fluids. Given that it has already been said that the elements encourage and control each other, this can be explained in this way:

� Wood stimulates fire: all the blood flows through the liver and directs it to the heart so that the heart can regulate its flow;

� Fire stimulates the earth: the heart gives the heat necessary for the proper functioning of the spleen;

� Earth stimulates the metal: the spleen transforms and transports essential nutrients and sends them to the lungs so that it can regenerate and support their activity;

� Metal stimulates water: the lungs send yin fluid to the kidneys;

� Water stimulates the tree: the essence of the kidneys renews the blood that goes further to the liver;

� Wood controls the soil: the cleansing effect of the liver prevents the spleen qi from stagnating;

� Fire controls the metal: the heartbeat prevents the lungs from being reduced to a minimum;

� Earth controls water: transport through the spleen prevents excessive fluid flow through the kidneys;

� Metal controls the wood: cleansing through the lungs allows less load on the liver�s qi;

� Water controls fire: the flow of yin through the kidneys alleviates the yin of the heart.

Visceral Zang and Fu theory

In traditional Chinese medicine, most human organs are divided into two groups: five zang and six fu organs.

The five zang organs are the heart, liver, spleen, lungs and kidneys, which are the most important organs in the human body. The six fu organs are the gall bladder, stomach, small and large intestine, bladder, and san jiao, all of which are important for the role of transporting and processing food and water.

The physiological functions of the heart were taken to control blood flow through blood vessels, support the mind, and control the tongue. It is a completely logical explanation of the role of the heart in circulation, and it was believed that the physiological function of the heart could affect the very mind of a human. Also, the tongue is connected to the heart by the cardiac meridian, so through this connection it is considered that the heart dominates the sense of taste on the tongue, but also speech, so it was believed that heart disease must manifest on the tongue.

The lungs played a basic role in respiration, controlling the decline and dispersion of qi, supporting the skin and hair, communicating with the throat and nasal openings, and are meridian-related to the colon. The lungs are a very important organ in TCM because they exchange qi that comes from outside and inside, and thus control the complete qi in the human body. Lung dysfunction can lead to qi disorders and cough or dyspnea.

The spleen is located in the so-called. medium energizer.

Its basic physiological function is the transport and transformation of water and food, and the control of blood and the maintenance of its normal circulation and the nutrition of muscles and four extremities. The spleen is connected to the lips and their condition reflects the condition of the spleen.

The liver is located in the right hypochondriac region and its main function is to store and regulate blood, support the free flow of qi, control tendons and open the eyes.

Changes in the state of the liver are associated with emotional changes such as depression or excitement. The condition of the liver in traditional Chinese medicine was reflected through the condition of the eyes since the liver was thought to nurture eye health through blood circulation.

The main role of the kidneys was to store congenital and acquired essence and control of human reproduction, regulate water distribution, receive qi as an assistant to the lungs, which�

represents their direct connection (lungs and kidneys). The condition of the kidneys was reflected in the physiological preservation of hearing, i.e. the ears, because it was considered that the kidneys, with their chi, nurture hearing and ears.

The gall bladder was considered to be directly related to the liver and the dysfunction in the physiological functions of the gall was thought to be reflected in changes in taste on the tongue i.e. an increased sense of bitterness.

Changes in emotional states associated with the liver are also associated with gall.

The stomach is considered the central organ of digestion and is directly connected to the gall bladder. Its basic physiological functions are food and water storage, appetite control and pain in the epigastric region. The optimal qi of the abdomen controls all five zang organs, so they will be filled with energy, and in the case of disturbed qi, the weakness of the same will be felt.

The small and large intestines are located in the lower part of the abdomen, and their role is the final digestion of food and the absorption of nutritional elements, i.e. the uptake of waste products from the small intestine into the large intestine. Diseases of the colon lead to disorders in the digestion of food and its transport, leading to constipation.

There is also the so-called san jiao organ whose basic physiological function is to control the qi activity of the whole organism. It is divided into three parts: the upper jiao is located just above the diaphragm and the heart and lungs are located there, the middle jiao is located between the diaphragm and the navel, and the spleen and abdomen are located there. The lower jiao is located just below the navel and is where the liver, kidneys, bladder, and intestines are located.

System of meridians and parallels The meridians (ying) and parallels (luo) represent the pathways through which qi and blood circulate. The meridians are the largest channels in the system and they extend vertically through the interior of the body, while the parallels are the branches of the meridians. Since they can be found throughout the whole body, they serve to interconnect zang-fu and other organs, openings of the body, skin, muscles and bones. They form a special network that communicates with all the internal organs of the body and limbs, and connect the upper part of the body with the lower. The meridian system consists of 12 basic meridians: three Yin meridians of the hand, three Yin meridians of the foot, three Yang meridians of the hand, and three Yang meridians of the foot; and of 8 additional meridians: Du, Ren, Chong, Dai, Yingqiao, Yangqiao, Yinwei and Yangwei. The eight additional meridians are not directly connected to the internal organs, but intersect with the 12 basic meridians and help them achieve normal communication.

The first meridian is the pulmonary channel of the hand (Taiyin) and it starts from the middle of the abdomen, reaches the large intestine and then returns to the diaphragm, passes through the lungs and then through the lungs and larynx to the surface of the right hand where it ends on the index finger (Figure 8).

The second meridian is the colon meridian of the colon Yangming which starts from the index finger of the right hand and extends along the lateral side of the forearm and the lateral side of the elbow. From the elbow, the front border of the upper arm reaches the highest point of the shoulder and at that point it branches into two branches.

One enters the body and passes through the lungs, diaphragm and colon, and the other passes through the outer part of the neck, cheeks and reaches the inner surfaces of the teeth in the lower jaw, ending in a circular motion around the lips and at a point corresponding to the height of the nose at the nape of the neck (Figure 9).

The abdominal meridian of the foot Yangming extends from the nose, through the diaphragm, spleen, colon, through the lateral side of the right foot to the tip of the middle toe (Figure 10).

The meridian of the spleen starts from the thick toe, extending along the inside of the foot to the outside of the ankle. From that point, the meridian extends along the inner side of the lower leg to the medial aspect of the knee and hip, and then enters the abdomen and spleen. From the spleen, the meridian extends to the chest, larynx, and root of the tongue. Another branch extends from the spleen to the heart and connects to the cardiac meridian (Figure 11).

The heart meridian of the hand Shaoyin is a meridian that has three branches and each starts from the heart.

One branch flow down to the diaphragm and small intestine.

The second branch of the meridian goes up to the larynx and ends in the eye. The third branch of the meridian passes through the chest and connects the heart to the lungs, and then goes to the armpits. From the armpit it goes down the medial side of the hand and ends at the tip of the little finger and connects with the meridian of the small intestine (Figure 12).

The small intestine meridian of the Taiyang hand begins where the previous meridian ends, from the tip of the little finger and extends to the posterior part of the shoulder and there encompasses the shoulder and continues further to the middle of the upper back and merges with the Du meridian. At this point, the meridian branches into two parts in which one part connects with the heart, diaphragm, abdomen, and small intestine, and the other part with the neck, cheeks, outer part of the eye, and enters the ear (Figure 13).

The bladder meridian Taiyang, starts from the inside of the eye and reaches the forehead to the side of the head.

One smaller branch then passes to the brain, and the main branch extends to the nape of the head and reaches the neck and spine. One part then branches and connects to the kidney, and the other part continues to the bladder.

The main part of the meridian continues through the buttocks, the knee and ends on the lateral side of the little toe and thus connects with the renal meridian (Figure 14).

The renal meridian from the foot Shaoyin begins on the inferior side of the little toe, passes through the ankle, the medial side of the lower leg, the hip, and enters the body where the lower part of the spine begins. Here the meridian branches and connects with the kidney and gall bladder, and then returns to the surface of the body and binds to the upper abdomen and chest. The branch associated with the kidney passes to the liver, diaphragm, and enters the lungs from where it passes through the larynx and ends at the root of the tongue (Figure 15).

The most famous herbal remedies of the Traditional Chinese Medicine Rheum rhabarbarum Rhubarb (Figure 16) has been used in Chinese pharmacy for thousands of years, and was first described by the mythical legend Shen Nung, although there are some opinions that the plant was used as far back as 2700 years before. According to Dioscorides, the roots of this plant were brought to Greece from the shores of the Bosphorus, it was not used much commercially during the Islamic era, it arrived in Europe during the 14th century where it was imported from Silk Street via the ports of Aleppo and Smyrna. It was then known as Turkish rhubarb. For centuries, the plant grew along the banks of the Volga river, whence its ancient name Rha. The expensive cost of transporting the plant from Asia made rhubarb a very prized and expensive plant�it was several times more expensive than cinnamon or opium. At one time, Marco Polo researched where this plant grows and picked it in the province of Tangut. Even in his report, Ambassador Ruy Gonzales de Clavijo wrote in 1403 that the best goods arriving in Samarkand from China certainly included rhubarb. The name rhubarb itself comes from the Greek words rha and barbarum.

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Figure 15. The renal meridian from the foot Shaoyin

Available at: http://cdn.intechopen.com/pdfs-wm/21300.pdf.

Accessed: March 20, 2017.

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Figure 17. Panax ginseng.

Available at: http://thisisnotacure.files.wordpress.com/2012/02/panax-ginseng.gif?w=714.

Accessed: March 22, 2017.

The word rha means both plant and river Volga. Rhubarb arrived in the USA in 1820, and was brought by Western European immigrants. Rhubarb is a perennial herbaceous plant that grows up to 3 meters high. The rhizome and root are very developed. It grows in the northern parts of China and in Tibet. The drug is represented by parts of peeled and dried rhizomes of several years old wild and cultivated rhubarb plants. The taste of the rhizome is bitter and it crunches under the teeth, it has a weak and specific smell.

Rhubarb rhizome contains anthraquinone heterosides.

Heterodiantron structures and their heterosides are also present in the rhizome. It has tannins, starch, pectin, resinous substances and calcium oxalate. In terms of action, anthraquinone heterosides have a laxative effect and tannins have an astringent effect. Rhubarb rhizome pollinated was used as a laxative in acute constipation, and in smaller doses it was used in digestive disorders.

Panax ginseng Ginseng root (Figure 17), due to its stimulating effect on the body, has long been used in concentrated form as a medicinal agent or in diluted form as a tea preparation.

The Chinese have noticed that regular consumption of ginseng improves the general condition of the body, appetite and mental activity, and has a preventive effect against many diseases. During the Vietnam War, ginseng was used by many Vietcong fighters, using it to treat the wounded who died in explosions. In the late fifties of the last century, Soviet scientists proved its extremely beneficial effect on raising the fitness of athletes, and it was used in the former Soviet Union to achieve top results.

The Russian Olympic team uses Siberian ginsengbased preparations on a daily basis. Japanese researchers have found that taking Siberian ginseng significantly improves the results of cyclists�by as much as 23 percent compared to athletes who do not take ginseng. Ginseng is also called the root of life.

Ginseng is one of the oldest, most widely used and most studied plants in the world. Although there are several plants called Ginseng and they all belong to the genus Panaxa, American Ginseng (Panax Quinquefolius) is believed to cool the body, so it is used in various fevers, while Asian Ginseng (Panax Ginseng) has the opposite effect and is used to improve circulation. Different types of Ginseng often symbolize the energy of yin (American) and yang (Asian), because their action is opposed to each other just like these ancient concepts. American Ginseng, in addition to cooling the body, increases energy and endurance, which is necessary for people who are stressed and live a modern fast-paced lifestyle. On the other hand, by relaxing the yang, this force opposed to cold yin, through the Asian plant helps the body recover and stimulates the whole body. Asian Ginseng (Panax Ginseng) is a perennial shrub, about 70 centimeters tall. From its stems grow leaves in the vertebrae. The fruits are bright red berries, with two seeds each, flattened in width. The dried root of the plant is most commonly used, although sometimes dried leaves that are less prized than the root can also be found. Ginseng was first discovered in China about 5000 years ago, in the Manchuria region. It quickly became appreciated for restoring strength and renewing energy, and its �human� form became a powerful symbol of divine harmony on earth.

In the first Chinese book on medicinal herbs �Classical Medicinal Plants� (Pen Tsao Ching) Ginseng is recommended for enlightening the mind and increasing wisdom. Ginseng grows in secluded places in the shady forests and hills of Korea, China and Russia. In ancient times, only wild Ginseng was used because it was long believed that Ginseng could not be grown because of its sensitivity and the special conditions in which it must grow, from the proper temperature to shady soil rich in minerals. Ginseng is known as an adaptogen, or agent that increases resistance to stress. It also strengthens the immune system, provides energy and vitality, rejuvenates the body by improving its functions. In addition to its excellent effect on the immune system, ginseng has a very beneficial effect on the nervous and cardiovascular system. It increases concentration, intellectual ability and memory, helps with headaches, insomnia and has an antidepressant effect. In addition, it detoxifies the blood, prevents anemia, lowers blood sugar and cholesterol levels, regulates blood pressure, improves circulation. It is an excellent antioxidant, and some research shows that it also helps in the treatment of cancer.

The best results are achieved in combination with other traditional Chinese plants. Wild American Ginseng was once widespread in all mountainous regions of the United States and Canada, and today it is an endangered species.

That is why it is now grown on farms to protect Wild Ginseng from over-harvesting. The Native Americans have traditionally used it as a stimulant and to treat headaches, fevers, indigestion and infertility. Like Asian, American Ginseng is an adaptogen, a plant that helps the body cope with various types of stress and is considered one of the most popular plants in the USA. Both American and Asian Ginseng contain ginsenosides, although the type and ratio of these substances differ in Asian and American herbs. American ginseng has a more relaxing effect than Asian Ginseng, which has a stimulating effect.

Animal laboratory studies have shown that American Ginseng is effective in boosting the immune system, as an antioxidant and has good potential in treating inflammatory diseases, diabetes, colds and flu and helping to treat cancer. Siberian Ginseng is also considered an adaptogen because plant extracts help the body adapt to stress. The regulatory action of Siberian Ginseng extract has been shown to be useful in meteorologists. Experiences from traditional medicine, as well as numerous studies conducted especially on Russian athletes, suggest a beneficial effect of Siberian Ginseng extract on the regulation of low blood pressure. Siberian Ginseng root preparations have found useful application in improving physical and mental condition (working ability), increasing the body�s general resistance and strengthening the heart, blood circulation and nerves. It is also used as an immunostimulant.

This herb can be taken long term.

Podophyllum peltatum

�

Figure 18. Podophyllum peltatum � plant which is used in Traditional Chinese medicine as laxative Available at: http://www.henriettes-herb.com/files/images/old/barton-w/w-barton-t25-podophyllum-peltatum.jpg.

Accessed: March 24, 2017.

It is a small woody perennial plant up to 30 centimeters tall. At the top of the shoots are two large, finger-divided leaves. Podophyllum peltatum (Figure 18) grows in the forests of the eastern part of the North American continent and in India in the Himalayas. The drug is a resin obtained from the ethanolic extract of the rhizome of this plant. The resin is a crumbly, amorphous mass, gray in color, with an extremely bitter taste and a specific odor.

The main pharmacologically active ingredients of the resin are podophyllotoxin and peltatins. Both inhibit the growth of experimentally induced tumors. These lignans prevent tubulin polymerization and the formation of dividing spindle microtubules, thus stopping cell division in metaphase. Rhizome and resin podophyllin have traditionally been used as a laxative and remedy against intestinal parasites. Today, this application has been abandoned due to its extreme toxicity. In the form of galenic preparations, they are rarely used for external use on the skin. Podophyllotoxin is a natural lignan that is the basis for obtaining synthetic derivatives of teniposide and etoposide. Etoposide is commonly used in combination chemotherapy for testicular and bronchial cancer, lymphoma, and acute leukemia. Teniposide is used in the treatment of lymphoma, acute leukemia, brain tumors and urogenital tumors.

Cinnamomum ceylanicum

Cinnamon (Figure 19) is first mentioned in the Chinese books from 2800 BC, where it is used for medical purposes for colds and digestive problems. It is also mentioned in the Bible, Moses used it in anointing oils, and the ancient Romans burnt it during burial, probably to neutralize unpleasant odors, among other things. Due to its pleasant smell, but also as a preservative, Egyptians used it in the process of mummification. Although today it is one of all known and present spices, cinnamon wasn�t always available. The search for cinnamon was one of the initiators of many quests in the 15th century. Given that it was delivered from afar, because it originally originated in Ceylon, and that the Venetians, in fact, had a monopoly on maritime routes, only the elite could afford the fragrant

Figure 19. Cinnamonum celyanicum- Ceylon cinnamon.

Available at: http://www.sacredearth.com/Ezine/winter09/ChineseCinn.gif.

Accessed: March 24, 2017.

and expensive spice. Due to the growing demand and use for medical and culinary purposes and high prices, traders have realized that by controlling the only place in the world where this spice grows, they have a monopoly on its placement, and thus control the world price. The first to secure a monopoly were Portuguese merchants� they reached Ceylon (bypassing the horn of Africa) in the 15th century. They tried to increase production, enslaved the local population and eliminated competition. Soon the Dutch intervened and in 1640, they suppressed the Portuguese and took control of the monopoly. Nor did the Dutch rule last forever, it was replaced by the English and by 1796 they had completely conquered the monopoly over the production and trade of cinnamon. However, it was also the end of the local cultivation of cinnamon, the plant spread to other parts, so that today cinnamon is neither a luxury nor an expensive spice. The spice, which was an exclusive product of Sri Lanka, is today grown in India, Sumatra, Java, Brazil, Vietnam, Egypt and Madagascar. In traditional Chinese medicine, cinnamon is used for colds, digestive problems, nausea. Chinese writings mention the beneficial use of cinnamon for people whose feet are always cold. The Egyptians used it in the process of embalming, but also for storing meat. The ancient Romans put cinnamon in many medicinal powders. It was used for colds but also as a room freshener�it was lit both in homes and in temples. Great use brought great demand and high price, so that Pliny the Elder in the first century noted that cinnamon is 15 times more valuable than silver.

Ayurvedic medicine treats diabetes with cinnamon, indigestion.

It is an integral part of tea cinnamon wasn�t used for better digestion, and the oil is used in aromatherapy for calming.

Numerous studies indicate a positive role of cinnamon in diet. For example, Swedish researchers from Malm� University Hospital examined the effects of cinnamon on human health and gave subjects rice pudding with or without cinnamon. In subjects whose pudding was sprinkled with cinnamon, the blood sugar level was significantly lower. Researchers believe that cinnamon slows down digestion, giving the body more time to break down carbohydrates. However, skeptics note that an insufficient sample�only fourteen respondents�calls this research into question. Another study from 2003 indicates the positive role of cinnamon in people with diabetes. In people with diabetes 2, if they take 1-6 grams of cinnamon a day, the glucose level is reduced after six months, in some by as much as 29%. Also, the level of triglycerides was reduced by 23-30%. Cinnamon also has an antifungal, antibacterial effect, and has been shown to be successful in persistent Helicobacter pylori infections. Cinnamon is always a green, short tree. The drug consists of peeled and dried bark of young branches of the cinnamon tree. A dozen thin covers are folded and dried quickly in the sun or in dryers. Otherwise, it comes in the form of gutter pieces that contain up to a dozen thin covers. The cortex of the cinnamon tree contains essential oil in the amount of 0.5 to 2.5%, and the essential oil contains cimetaldehyde, cinnamic acid, eugenol, limonene and alphaterpineol.

The cortex also contains coumarin mucus and tannins. Cinnamon essential oil has a characteristic aroma and exhibits antibacterial activity. In combination with other drugs, it also has an antispasmodic effect. Powdered cortex is used for digestive disorders and painful spasm of smooth muscles. The oil is used as a flavoring agent for some pharmaceutical preparations, as well as for the production of aromatic water and in the perfume industry. The largest amounts of cortex and essential oil are used as a spice.

Ephedra sinica Ephedra (Figure 20) is a plant of Chinese origin and is known in China as ma huang, it has been used traditionally for over 5000 years. Indeed, there are several species of the genus Ephedra that are used for various medicinal purposes, and have often been used in the preparation of the Soma solution used in the Indo-Iranian religion. It was also used by the Indians in the preparation of Indian tea.

The ephedra is a low branched shrub. The drug makes up the dried, above-ground, herbaceous part of the plant in bloom. Herb ephedra contains flavonoids and proanthocyanidins but the most important ingredients are protoalkaloids.

The most important are ephedrine and pseudoephedrine.

Ephedrine is an indirect sympathomimetic. It works similar to adrenaline, but weaker. The anti-inflammatory action of pseudoephedrine has been experimentally confirmed. It is used in the treatment of asthma, bronchitis and febrile conditions. In the form of drops, it is used in the treatment of diseases of the nose and eyes: it narrows blood vessels and acts as a mild local anesthetic.

Wolfiporia cocos Fuling (Figure 21) has been used in Traditional Chinese

�

Figure 20. Ephedra sinica � herb which is used in Traditional Chinese Medicine for treating asthma and bronchitis.

Available at: http://www.itmonline.org/image/ma1.JPG

Accessed: March 25, 2017.

Medicine for thousands of years. Due to its multiple medicinal effects, this mushroom is considered, according to Chinese tradition, one of the eight treasures. Fuling mushroom is used in Chinese medicine to make a large number of medicines, but also delicacies and snacks for the richest families, including the royal vine.

This mushroom is characterized by several names, such as Poria cocos, Indian barrel, Chinese root, Fu Ling Pi, Fu Shen, hoelen, etc. Today, this mushroom can be found in the wild, but is also cultivated in places such as Yunnan, Anhui, Hubei, Henan, Sichuan, etc., and the best quality comes from Yunnan.

The healing effects of fuling stem from its rich chemical composition. Triterpenoids, polysaccharides, ergosterol, caprylic acid, undecanoic acid, lauric acid, dodecanoic acid, palmitic acid, caprylates and other elements can

Figure 21. Fuling mushroom � often used mushroom in TCM. Available at:

http://www.chineseherbshealing.com/poria-fu-ling/. Accessed: March 27, 2017.

be found in the flesh of this fungus. Of the triterpenoids, the most important are pachymic acid, tumuloic acid, Cmethyl ester of polypenic acid, methyl ester of tumulose acid, etc., and the most important polysaccharides are pachyman, pachymaran and gluan H11.

In Traditional Chinese Medicine, but also in modern pharmacological tests, it has been established that this fungus has the following effects:

� Diuretic effect: fuling mushroom itself has no diuretic effect, but in a combination called Wu Ling

San, it shows a pronounced diuretic effect;

� Antibacterial effect: in vitro experiments have shown that the ethanol extract of this fungus can have a bactericidal effect on leptospires;

� Digestive system: fuling can relax the intestines, reduce the strength of stomach acid and prevent ulcers in the stomach or small intestine;

� Regulation of blood sugar;

� Enhances heart contractility.

Cordyceps sinensis � Chinese caterpillar mushroom

Cordyceps (Figure 22) is a mushroom native to Tibet, be found in the flesh of this fungus. Of the triterpenoids, the most important are pachymic acid, tumuloic acid, Cmethyl ester of polypenic acid, methyl ester of tumulose acid, etc., and the most important polysaccharides are pachyman, pachymaran and gluan H11.

In Traditional Chinese Medicine, but also in modern pharmacological tests, it has been established that this fungus has the following effects:

� Diuretic effect: fuling mushroom itself has no diuretic effect, but in a combination called Wu Ling

San, it shows a pronounced diuretic effect;

� Antibacterial effect: in vitro experiments have shown that the ethanol extract of this fungus can have a bactericidal effect on leptospires;

� Digestive system: fuling can relax the intestines, reduce the strength of stomach acid and prevent ulcers in the stomach or small intestine;

� Regulation of blood sugar;

� Enhances heart contractility.

Cordyceps sinensis � Chinese caterpillar mushroom

Cordyceps (Figure 22) is a mushroom native to Tibet,

Figure 22. Cordyceps � a mushroom which attacks caterpillars and it grows out of their corpse.

Available at: http://www.pecurke-sitake.com/kordiceps-gljiva.php

Accessed: March 27, 2017.

China, and grows at an altitude of 5,000 meters. Its price is extremely high, and it costs up to 3000 USD per kilogram.

Precisely because of the great demand, and also because of the difficulties in finding the mushroom itself, it was given for medicinal purposes only to noble families and the King of China himself. Its natural nutritional basis is not like other fungi, but it is a type of caterpillar. The mushroom attacks these caterpillars, kills them and then sprouts out of them with its finger-like body. Scientists have been trying to grow this mushroom for a long time, since its natural reproduction does not meet world demand, but everything has remained to be tried.

In traditional Chinese medicine, this mushroom is used to strengthen the lungs and kidneys, as well as to tone yin yang. It is believed to calm emotions, remove mucus and prevent bleeding. It has a positive effect on cancer control, treatment of rheumatism, fatigue, respiratory diseases, inflammation, insomnia and irregular men-struation. Cordyceps improves the supply of tissues and organs with blood and oxygen. It has been scientifically proven that this mushroom has antimicrobial action and that it stops the growth of the bacterium Clostridium without breaking down bifidobacteria and lactobacilli in the intestines. Studies have also shown a significant increase in the activity of natural cells that kill cancer cells (macrophages).

Acupuncture as a method of treatment in Traditional Chinese Medicine Acupuncture is a method of treatment using needles that are inserted into specific points on the body, and which the Chinese have mapped during the long history of TCM. The goal is to stimulate energy centers and improve the flow of qi through the body. It is a word of Latin origin (acus�needle, pungere�to prick), and it was the name given to it by European missionaries who visited China at the end of the 16th century and were the first to bring the word of healing in this way. The origin of acupuncture is related to the story of a warrior wounded by an arrow. The arrow was taken out and the wound healed, and it was later noticed that the disease had healed on another part of his body. The first needles used by the Chinese were stone, then bone and bamboo, while today disposable surgical steel needles are used. In addition to classical acupuncture, electroacupuncture is increasingly used to perform surface electrostimulation through the skin. Acupuncture points are stimulated with a special probe (sticks) without stabbing.

In 1979, the World Health Organization recognized acupuncture as an equal branch of medicine because it meets standards that are in line with modern methods of treatment. It is accepted that it can be used as the only therapy, in combination with another method of treatment or as an adjuvant therapy. Its indication area is very wide, and the effect is observed in 70-80% of cases. On that occasion, a list of diseases that are successfully treated with this method was compiled. Some of them are: sinusitis, constipation, headaches, migraines, neuralgia, pain of the skeletal and muscular system, bronchitis, asthma, ulcers, infertility, menstrual problems, insomnia, various skin diseases, diabetes, hemorrhoids, etc.

Acupuncture has been shown to be very effective in relieving postoperative pain, nausea and vomiting due to chemotherapy and radiation. Acupuncture follows the development of technology and successfully follows modern achievements, so there was the emergence of electroacupuncture, fluid acupuncture, laser acupuncture and the like. The method of laser acupuncture is non-invasive, painless and shortterm therapy. The exact mechanism of action of lowpower laser energy has not been fully elucidated. At the cellular level, the basic processes that lead to the healing of cells, tissues, organs and the organism as a whole are accelerated or slowed down. Biological changes are a consequence not only of the immediate effect of the laser, but also of the host response consisting in a change in metabolic activities lasting up to a month. The advantages of laser acupuncture are: asepsis, painlessness, economy and possible application on any part of the body, skin or mucous membranes.

Acupuncture and moxibustion are specific methods by which internal diseases are treated by �external� methods. Thus a variety of diseases can be cured using methods that require absolute knowledge of the internal channels and the flow of qi through them. In order for someone to perform acupuncture, it is necessary to know the theory of �eight principles�, zang-fu theory and the flow and arrangement of meridians and parallels through the human body. After discovering the channel or internal organ that is damaged, it is necessary to find out the mechanism of the disease and determine the essence and secondary symptoms, and only then decide on acupuncture or moxibustion, and whether there should be a method of strengthening or reducing. The basic principle of acupuncture treatment is: the method of strengthening should be applied in xu (deficiency) syndrome, and the method of reduction for shi (excess) syndrome. Moxibustion is applied when vital function or yang is declining.

Acupuncture is based on the selection of three puncture points:

� Selection of distant points (e.g. if treating a facial disease, points located on the lower part of the body are selected);

� Selection of local points (in case of a wound, points close to the wound are selected) and;

� Selection of adjacent points (if local points cannot be selected, the so-called adjacent points are selected to strengthen the therapeutic effect).

5. DISCUSSION

History is overfull with mythology in the case of the Three Kings of Heaven who are revered as the founders of Chinese civilization. Fu Hsi, who is thought to have ruled 2000 years before Christ, is the legendary founder of the first Chinese dynasty. His most important inventions included writing, painting, music, original mythical trigrams, and the yin-yang concept. During a century of rule, Huang Ti, the last of the three legendary Heavenly Emperors, gave his people a wheel, a magnet, an observatory, a calendar, the art of measuring heart rate, and the Huang-ti Nei Ching (Yellow Emperor�s Canon of Internal Medicine) �a text that inspired and guided Chinese medical thought over 2500 years. Like many ancient texts, the Nei Ching has been corrupted over the centuries with additions, cutouts, and typographical errors.

Scholars agree that the existing text is very old, perhaps even dating back to the first century BC, but the time of its compilation is polemical. Most historians believe that the existing text was composed at the beginning of the T�ang dynasty (618-907).

The first records of traditional Chinese medicine (TCM) date back to 5000 years ago. TCM encompasses Han medicine and the theories and practices of various national minorities from China such as Miao, Dai, Mongols and Tibetans. The first records of TCM appear from the period 2698-2598 years before the new era, during the era of Huangdi or the Yellow Ruler. However, the duties and responsibilities of physicians were defined only later, in 1122 BC, during the Zhou dynasty. At the time, every large estate had its own physician, and it was characteristic that physicians were paid when the householders were healthy, not when they fell ill. Thus, the primary concern of physicians was to maintain health and prevent disease, not to treat it. TCM is the oldest continuously practiced, scientific medical system in the world. It should certainly not be classified as an expression of folk medicine, nor quackery, because TCM is a complex and precise health care system created from the efforts of great Chinese minds to understand the secrets of the functioning of the human body. In its beginnings, TCM was a practical and effective art based on observations and experience with the application of philosophical principles such as Yin and Yang or wu-xing (the theory of the five elements).

The basic thinking was that health can be maintained if there is a balance of the human body with the inner spirit and the outer environment. For this reason, diagnosis and treatment were based on targeted finding of imbalance and its return to normal. The greatest success and development of TKM was experienced during the Ming Dynasty (1368-1644), culminating in the publication of the Compendium of Material Medica (Figure 5) by Li Shizhen. Li Shizhen has dedicated himself to gathering the most important and credible medical experiences over 30 years and has singled out a total of 1,094 herbal medicines, 443 animal medicines and 354 mineral medicines.

For each drug, an adequate name, source, form and medical history were prescribed, as well as the manner in which it was collected, prepared, stored and dosed.

Modern TCM theory has emerged from the naturalistic philosophies of ancient China with special influences of experiences that have accumulated through generations and generations. TCM may seem outdated and charlatan today, but it is a complete, integrated method of interpreting human physiology and pathological changes in the body. The most important concepts of TCM are qi, yin yang and the theory of the five elements (wuxing). Theoretical concepts of specific TCM include the doctrine of zheng ti guang nian, the concepts of viscera and compassion (zangfu xue shuo), channels and networks (jingluo), bodily substances (qi, blood, essence and body fluids qi xue jing jinye) and pathological agents (bing yin). All these theories, together with the methodologies of the four methods (si zhen) and basic discrimination (bian zheng) form the theoretical basis of TCM. Each of the therapeutic methods of TCM, such as acupuncture and moxibustion (zhenjiu), Chinese herbology (zhongyao fang), and Chinese therapeutic massage (zhongyi tuina) are based on the stated theoretical foundations.

The basic concept of qi theory is that qi is the basic substance from which the entire universe is built and that all objects in the universe are born by the transformation of qi. Ancient philosophers argued that qi could exist in two states: dispersion and condensation, and these two states of qi determine two modes of perception in man: one having a form and one without a form.

According to ancient Chinese philosophy, yin and yang represent two essentially opposite categories. At first, their understanding was simple, describing the turning of the face or back to sunlight. It was later introduced into the theory that yin and yang refer to almost all imaginable opposites, such as time, position, side of the world, state, etc. Ancient Chinese philosophers wisely observed that for every phenomenon there are two opposing aspects with each other. Thus, yang represents phenomena such as speech, active state, external, upper, warm, light, while yin is associated with opposite phenomena: silence, inactive state, internal, lower, cold, dark.

The theory of the five elements/phases establishes such a system of correspondence that all phenomena in the universe can be classified into five categories. The categories represent a tendency to move and transform in the universe and are related to natural phenomena such as wood (mu), fire (huo), earth (tu), metal (yin) and water (shui). A constant connection between them is used to explain changes in nature. In traditional Chinese medicine, most human organs are divided into two groups: five zang and six fu organs. The five zang organs are the heart, liver, spleen, lungs and kidneys, which are the most important organs in the human body. The six fu organs are bile, stomach, small and large intestine, bladder, and san jiao, all of which are important for the role of transporting and processing food and water.

The meridians (ying) and parallels (luo) represent the pathways through which qi and blood circulate. The meridians are the largest channels in the system and they extend vertically through the interior of the body, while the parallels are the branches of the meridians. Since they can be found throughout the whole body, they serve to interconnect zang-fu and other organs, openings of the body, skin, muscles and bones. They form a special network that communicates with all the internal organs of the body and limbs, and connects the upper part of the body with the lower. The meridian system consists of 12 basic meridians: three Yin meridians of the hand, three Yin meridians of the foot, three Yang meridians of the hand, and three Yang meridians of the foot; and of 8 additional meridians: Du, Ren, Chong, Dai, Yingqiao, Yangqiao, Yinwei and Yangwei. The eight additional meridians are not directly connected to the internal organs but intersect with the 12 basic meridians and help them to achieve normal communication.

Acupuncture is a method of treatment using needles that are inserted into specific points on the body, and which the Chinese have mapped during the long history of TCM. The goal is to stimulate energy centers and improve the flow of qi through the body. It is a word of Latin origin (acus�needle, pungere�to prick), and it was called by European missionaries who visited China at the end of the 16th century and were the first to bring word about healing in this way. The origin of acupuncture is related to the story of a warrior wounded by an arrow. The arrow was taken out and the wound healed, and it was later no ticed that the disease had healed on another part of his body. The first needles used by the Chinese were stone, then bone and bamboo cane, and today disposable surgical steel needles are used.

6. CONCLUSION

Traditional Chinese medicine has managed to resist time and has existed for 5000 years, since when there is the first record of its practice. Although the word is traditional in the name, it follows the development of modern medicine, so the World Health Organization (WHO) has accepted it as a scientifically proven medicine. Experiences of treatment with drugs from Greak, Persian and Arabic medicine, Traditional medicine has been accepted as official Complementary medicine in daily praxis, recommended by WHO (18-24). The basis of traditional Chinese medicine consists of several theories, such as zang-fu organs, yin and yang, qi, the theory of the five elements and the concept of meridians and parallels. All theories are interconnected and form one complicated whole. Yin and yang and qi are perhaps the most important aspect of traditional Chinese medicine because everything is based on balancing the energy of qi and the balance between yin and yang. Certainly, the most complicated aspect of traditional Chinese medicine is acupuncture, which requires detailed knowledge of all five theories and knowledge of key points on the human body and their interrelationship, all for the purpose of treating certain diseases and balancing qi and balancing yin and yang.

� Authors contribution: All authors were included in preparation of this article. Final proof reading was made by the Tarik Catic and Izet Masic.

� Conflict of interest: None declared.

� Financial support and sponsorship: Nil

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1.2.3.2 History of Acupuncture ^w

Acupuncture can be traced back to the primitive society of China, which is divided into two time periods

The old stone age (10,000 years ago and beyond) and the new stone age (10,000-4000 years ago).

During the old stone age knives were made of stone and were used for certain medical procedures.

During the new stone age, stones were refined into fine needles and served as instruments of healing. They were named bian stone � which means use of a sharp edged stone to treat disease.

The most significant milestone in the history of Acupuncture occurred during the period of Huang Di �The Yellow Emperor (2697-2597).

In a famous dialogue between Huang Di and his physician Qi Bo, they discuss the whole spectrum of the Chinese Medical Arts. These conversations would later become the monumental text � The Nei Jing (The Yellow Emperors Classic of Internal Medicine).

The most significant milestone in the history of Acupuncture occurred during the period of Huang Di �The Yellow Emperor (2697-2597).

During the Shang Dynasty (1000 BC) , hieroglyphs showed evidence of Acupuncture and Moxibustion. Bronze needles were excavated from ruins, but the bian stones remained the main form of needle.

During the Warren States Era (421-221 B.C.) metal needles replaced the bian stones. The Miraculous Pivot names nine types of Acupuncture needles. The historical records notes many physicians practicing Acupuncture during this time. Another milestone for this period was the compilation of the Nan Jing (Book of Difficult Questions). The Nan Jing discusses five element theory, hara diagnosis, eight extra meridians, and other important topics.

From 260-265 A.D., the famous physician Huang Fu Mi, organized all of the ancient literature into his classic text � Systematic Classics of Acupuncture and Moxibustion.

The text is twelve volumes and describes 349 Acupuncture points. It is organized according to the theory of: zang fu, Qi and blood, channels and collaterals, acupuncture points, and clinical application. This book is noted to be one of the most influential texts in the history of Chinese Medicine.

Acupuncture experienced great development during the Sui (581-618) and Tang (618-907) Dynasties. Upon request from the Tang Government (627-649A.D.), the famous physician Zhen Quan revised the important Acupuncture texts and charts.

From 260-265 A.D., the famous physician Huang Fu Mi, organized all of the ancient literature into his classic text � Systematic Classics of Acupuncture and Moxibustion.

1601 � Yang Jizhou wrote Zhenjin Dacheng (Principles of Acupuncture and Moxibustion). This great treatise on Acupuncture reinforced the principles of the Nei Jing and Nan Jing. This work was the foundation of the teachings of G. Soulie de Morant who introduced Acupuncture into Europe.

From the Qing Dynasty to the Opium Wars (1644-1840), herbal medicine became the main tool of physicians and Acupuncture was suppressed.

Following the revolution of 1911, Western Medicine was introduced and Acupuncture and Chinese Herbology were suppressed

�Due to the large population and need for medical care, Acupuncture and herbs remained popular among the folk people, and the �barefoot doctor� emerged.

In 1950 Chairman Mao Zedong officially united Traditional Chinese Medicine with Western Medicine, and acupuncture became established in many hospitals

In the same year Comrade Zhu De reinforced Traditional Chinese Medicine with his book New Acupuncture

�Acupuncture gained attention in the United States when President Richard Nixon visited China in 1972.

� During one part of the visit, the delegation was shown a patient undergoing major surgery while fully awake, ostensibly receiving acupuncture rather than anesthesia.

The Ming Dynasty (1568-1644) was the enlightening period for the advancement of Acu-puncture. Many new developments included:

- Revision of the classic texts

- Refinement of Acupuncture techniques and manipulation

- Development of Moxa sticks for indirect treatment

- Development of extra points outside the main meridians

- The encyclopaedic work of 120 volumes- Principle and Practice of Medicine was written by the famous physician Wang Gendung

The greatest exposure in the West came when New York Times reporter James Reston, who accompanied Nixon during the visit, received acupuncture in China for post-operative pain after undergoing an emergency appendectomy under standard anaesthesia.

Reston believed he had pain relief from the acupuncture and wrote it in The New York Times.

In 1973 the American Internal Revenue Service allowed acupuncture to be deducted as a medical expense. This sparked an intense interest in acupuncture by the public.

Several months later, a report favourable to acupuncture was published in the Journal of the American Medical Association.

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1.2.3.3 Feng shui ^w

Feng shui (/ˈfʌŋˌʃuːi/), also known as Chinese geomancy, is an ancient Chinese traditional practice which claims to use energy forces to harmonize individuals with their surrounding environment. The term feng shui means, literally, "wind-water". From ancient times, landscapes and bodies of water were thought to direct the flow of the universal Qi � �cosmic current� or energy � through places and structures. Because Qi has the same patterns as wind and water, a specialist who understands them can affect these flows to improve wealth, happiness, long life, and family; on the other hand, the wrong flow of Qi brings bad results. More broadly, feng shui includes astronomical, astrological, architectural, cosmological, geographical, and topographical dimensions.

Feng shui analysis of a 癸山丁向 site, with an auspicious circle

Feng shui

Chinese name

Traditional Chinese 風水

Simplified Chinese 风水

Literal meaning "wind-water"

Transcriptions

Standard Mandarin

Hanyu Pinyin �� fēngshuǐ

Bopomofo �� ㄈㄥㄕㄨㄟˇ

Wade�Giles �� f�ng1-shui3

Tongyong Pinyin �� fongshuěi

Yale Romanization �� fēngshwěi

IPA �� [fə́ŋ.ʂwèɪ]

Romanization �� fon平 sy上

Gan

Romanization �� Fung1 sui3

Hakka

Romanization �� fung24 sui31

Yue: Cantonese

Yale Romanization �� f�ngs�ui or fūngs�ui

Jyutping �� fung1seoi2

IPA �� [fôŋ.sɵ̌y] or [fóŋ.sɵ̌y]

Southern Min

Hokkien POJ hong-su�

Eastern Min

Fuzhou BUC �� hŭng-cūi

Vietnamese name

Vietnamese �� phong thủy

H�n-N�m 風水

Thai name

Thai �� ฮวงจุ้ย (Huang chui)

Korean name

Hangul �� 풍수

Hanja �� 風水

Transcriptions

Revised Romanization �� pungsu

McCune�Reischauer �� p'ungsu

Japanese name

Kanji �� 風水

Hiragana �� ふうすい

Transcriptions

Revised Hepburn �� fūsui

Kunrei-shiki �� h�sui

Filipino name

Tagalog �� Pungs�y, Puns�y

Khmer name

Khmer �� ហុងស៊ុយ (hongsaouy)

Historically, as well as in many parts of the contemporary Chinese world, feng shui was used to orient buildings and spiritually significant structures such as tombs, as well as dwellings and other structures. One scholar writes that in contemporary Western societies, however, �feng shui tends to be reduced to interior design for health and wealth. It has become increasingly visible through 'feng shui consultants' and corporate architects, who charge large sums of money for their analysis, advice, and design.�

Feng shui has been identified as both non-scientific and pseudoscientific by scientists and philosophers, and has been described as a paradigmatic example of pseudoscience. It exhibits a number of classic pseudoscientific aspects, such as making claims about the functioning of the world which are not amenable to testing with the scientific method. Some users of feng shui may be trying to gain a sense of security or control. Their motivation is similar to the reasons that some people consult fortune-tellers.

HISTORY

ORIGINS

As of 2013, the Yangshao and Hongshan cultures provide the earliest known evidence for the use of feng shui. Until the invention of the magnetic compass, feng shui relied on astronomy to find correlations between humans and the universe.

In 4000 BC, the doors of dwellings in Banpo were aligned with the asterism Yingshi just after the winter solstice�this sited the homes for solar gain. During the Zhou era, Yingshi was known as Ding and it was used to indicate the appropriate time to build a capital city, according to the Shijing. The late Yangshao site at Dadiwan (c. 3500�3000 BC) includes a palace-like building (F901) at its center. The building faces south and borders a large plaza. It stands on a north�south axis with another building that apparently housed communal activities. Regional communities may have used the complex.

A grave at Puyang (around 4000 BC) that contains mosaics� a Chinese star map of the Dragon and Tiger asterisms and Beidou (the Big Dipper, Ladle or Bushel)� is oriented along a north�south axis. The presence of both round and square shapes in the Puyang tomb, at Hongshan ceremonial centers and at the late Longshan settlement at Lutaigang, suggests that gaitian cosmography (heaven-round, earth-square) existed in Chinese society long before it appeared in the Zhoubi Suanjing.

Cosmography that bears a resemblance to modern feng shui devices and formulas appears on a piece of jade unearthed at Hanshan and dated around 3000 BC. Archaeologist Li Xueqin links the design to the liuren astrolabe, zhinan zhen, and luopan.

Beginning with palatial structures at Erlitou, all capital cities of China followed rules of feng shui for their design and layout. During the Zhou era, the Kaogong ji (Chinese: 考工記; "Manual of Crafts") codified these rules. The carpenter's manual Lu ban jing (魯班經; "Lu ban's manuscript") codified rules for builders. Graves and tombs also followed rules of feng shui, from Puyang to Mawangdui and beyond. From the earliest records, the structures of the graves and dwellings seem to have followed the same rules.

EARLY INSTRUMENTS AND TECHNIQUES

Some of the foundations of feng shui go back more than 3,500 years before the invention of the magnetic compass. It originated in Chinese astronomy. Some current techniques can be traced to Neolithic China, while others were added later (most notably the Han dynasty, the Tang, the Song, and the Ming).

The astronomical history of feng shui is evident in the development of instruments and techniques. According to the Zhouli, the original feng shui instrument may have been a gnomon.

Chinese used circumpolar stars to determine the north�south axis of settlements. This technique explains why Shang palaces at Xiaotun lie 10� east of due north. In some of the cases, as Paul Wheatley observed, they bisected the angle between the directions of the rising and setting sun to find north. This technique provided the more precise alignments of the Shang walls at Yanshi and Zhengzhou. Rituals for using a feng shui instrument required a diviner to examine current sky phenomena to set the device and adjust their position in relation to the device.

The oldest examples of instruments used for feng shui are liuren astrolabes, also known as shi. These consist of a lacquered, two-sided board with astronomical sightlines. The earliest examples of liuren astrolabes have been unearthed from tombs that date between 278 BC and 209 BC. Along with divination for Da Liu Ren the boards were commonly used to chart the motion of Taiyi through the nine palaces. The markings on a liuren/shi and the first magnetic compasses are virtually identical.

The magnetic compass was invented for feng shui and has been in use since its invention.

Traditional feng shui instrumentation consists of the Luopan or the earlier south-pointing spoon (指南針 zhinan zhen)�though a conventional compass could suffice if one understood the differences. A feng shui ruler (a later invention) may also be employed.

A feng shui spiral at Los Angeles Chinatown's Metro station

DEFINITION AND CLASSIFICATION

The goal of feng shui as practiced today is to situate the human-built environment on spots with good qi, an imagined form of "energy". The "perfect spot" is a location and an axis in time.

Traditional feng shui is inherently a form of ancestor worship. Popular in farming communities for centuries, it was built on the idea that the ghosts of ancestors and other independent, intangible forces, both personal and impersonal, affected the material world, and that these forces needed to be placated through rites and suitable burial places, which the feng shui practitioner would assist with for a fee. The primary underlying value was material success for the living.

According to Stuart Vyse, feng shui is "a very popular superstition." The PRC government has also labeled it as superstitious. Feng shui is classified as a pseudoscience since it exhibits a number of classic pseudoscientific aspects such as making claims about the functioning of the world which are not amenable to testing with the scientific method. It has been identified as both non-scientific and pseudoscientific by scientists and philosophers, and has been described as a paradigmatic example of pseudoscience.

Qi (ch'i)

FOUNDATIONAL CONCEPTS

A traditional turtle-back tomb of southern Fujian, surrounded by an omega-shaped ridge protecting it from the "noxious winds" from the three sides

Qi (气, pronounced "chee") is a movable positive or negative life force which plays an essential role in feng shui. The Book of Burial says that burial takes advantage of "vital qi". The goal of feng shui is to take advantage of vital qi by appropriate siting of graves and structures.

POLARITY

Polarity is expressed in feng shui as yin and yang theory. That is, it is of two parts: one creating an exertion and one receiving the exertion. The development of this theory and its corollary, five phase theory (five element theory), have also been linked with astronomical observations of sunspot.

The Five Elements or Forces (wu xing) � which, according to the Chinese, are metal, earth, fire, water, and wood � are first mentioned in Chinese literature in a chapter of the classic Book of History. They play a very important part in Chinese thought: �elements� meaning generally not so much the actual substances as the forces essential to human life. Earth is a buffer, or an equilibrium achieved when the polarities cancel each other. While the goal of Chinese medicine is to balance yin and yang in the body, the goal of feng shui has been described as aligning a city, site, building, or object with yin-yang force fields.

Bagua (eight trigrams)

Eight diagrams known as bagua (or pa kua) loom large in feng shui, and both predate their mentions in the Yijing (or I Ching). The Lo (River) Chart (Luoshu) was developed first, and is sometimes associated with Later Heaven arrangement of the bagua. This and the Yellow River Chart (Hetu, sometimes associated with the Earlier Heaven bagua) are linked to astronomical events of the sixth millennium BC, and with the Turtle Calendar from the time of Yao. The Turtle Calendar of Yao (found in the Yaodian section of the Shangshu or Book of Documents) dates to 2300 BC, plus or minus 250 years.

In Yaodian, the cardinal directions are determined by the marker-stars of the mega-constellations known as the Four Celestial Animals:

East: The Azure Dragon (Spring equinox)�Niao (Bird 鳥), α Scorpionis

South: The Vermilion Bird (Summer solstice)�Huo (Fire 火), α Hydrae

West: The White Tiger (Autumn equinox)�Mǎo (Hair 毛), η Tauri (the Pleiades)

North: The Black Tortoise (Winter solstice)�Xū (Emptiness, Void 虛), α Aquarii, β Aquarii

The diagrams are also linked with the sifang (four directions) method of divination used during the Shang dynasty. The sifang is much older, however. It was used at Niuheliang, and figured large in Hongshan culture's astronomy. And it is this area of China that is linked to Yellow Emperor (Huangdi) who allegedly invented the south-pointing spoon (see compass).

Traditional feng shui is an ancient system based upon the observation of heavenly time and earthly space. Literature, as well as archaeological evidence, provide some idea of the origins and nature of feng shui techniques. Aside from books, there is also a strong oral history. In many cases, masters have passed on their techniques only to selected students or relatives.

Modern practitioners of feng shui draw from several branches in their own practices.

FORM BRANCH

The Form Branch is the oldest branch of feng shui. Qing Wuzi in the Han dynasty describes it in the Book of the Tomb and Guo Pu of the Jin dynasty follows up with a more complete description in The Book of Burial.

The Form branch was originally concerned with the location and orientation of tombs (Yin House feng shui), which was of great importance. The branch then progressed to the consideration of homes and other buildings (Yang House feng shui).

The "form" in Form branch refers to the shape of the environment, such as mountains, rivers, plateaus, buildings, and general surroundings. It considers the five celestial animals (phoenix, green dragon, white tiger, black turtle, and the yellow snake), the yin-yang concept and the traditional five elements (Wu Xing: wood, fire, earth, metal, and water).

The Form branch analyzes the shape of the land and flow of the wind and water to find a place with ideal qi. It also considers the time of important events such as the birth of the resident and the building of the structure.

COMPASS BRANCH

The Compass branch is a collection of more recent feng shui techniques based on the Eight Directions, each of which is said to have unique qi. It uses the Luopan, a disc marked with formulas in concentric rings around a magnetic compass.

TRADITIONAL FENG SHUI

The Compass Branch includes techniques such as Flying Star and Eight Mansions.

More recent forms of feng shui simplify principles that come from the traditional branches, and focus mainly on the use of the bagua.

ASPIRATIONS METHOD

The Eight Life Aspirations style of feng shui is a simple system which coordinates each of the eight cardinal directions with a specific life aspiration or station such as family, wealth, fame, etc., which come from the Bagua government of the eight aspirations. Life Aspirations is not otherwise a geomantic system.

Ti Li (Form Branch)

Popular Xingshi Pai (形勢派) "forms" methods

Luan Tou Pai, 巒頭派, Pinyin: lu�n t�u p�i, (environmental analysis without using a compass)

Xing Xiang Pai, 形象派 or 形像派, Pinyin: x�ng xi�ng p�i, (Imaging forms)

Xingfa Pai, 形法派, Pinyin: x�ng fǎ p�i

Liiqi Pai (Compass Branch)

Popular Liiqi Pai (理气派) "Compass" methods

San Yuan Method, 三元派 (Pinyin: sān yu�n p�i)

Dragon Gate Eight Formation, 龍門八法 (Pinyin: l�ng m�n bā fǎ)

Xuan Kong, 玄空 (time and space methods)

Xuan Kong Fei Xing 玄空飛星 (Flying Stars methods of time and directions)

Xuan Kong Da Gua, 玄空大卦 ("Secret Decree" or 64 gua relationships)

Xuan Kong Mi Zi, 玄空秘旨 (Mysterious Space Secret Decree)

Xuan Kong Liu Fa, 玄空六法 (Mysterious Space Six Techniques)

Western forms of feng shui

List of specific feng shui branches

Zi Bai Jue, 紫白訣 (Purple White Scroll)

San He Method, 三合派 (environmental analysis using a compass)

Accessing Dragon Methods

Ba Zhai, 八宅 (Eight Mansions)

Yang Gong Feng Shui, 楊公風水

Water Methods, 河洛水法

Local Embrace

Others

Yin House Feng Shui, 陰宅風水 (Feng Shui for the deceased)

Four Pillars of Destiny, 四柱命理 (a form of hemerology)

Zi Wei Dou Shu, 紫微斗數 (Purple Star Astrology)

I-Ching, 易經 (Book of Changes)

Qi Men Dun Jia, 奇門遁甲 (Mysterious Door Escaping Techniques)

Da Liu Ren, 大六壬 (Divination: Big Six Heavenly Yang Water Qi)

Tai Yi Shen Shu, 太乙神數 (Divination: Tai Yi Magical Calculation Method)

Date Selection, 擇日 (Selection of auspicious dates and times for important events)

Chinese Palmistry, 掌相學 (Destiny reading by palm reading)

Chinese Face Reading, 面相學 (Destiny reading by face reading)

Major & Minor Wandering Stars (Constellations)

Five phases, 五行 (relationship of the five phases or wuxing)

BTB Black (Hat) Tantric Buddhist Sect (Westernised or Modern methods not based on Classical teachings)

Symbolic Feng Shui, (New Age Feng Shui methods that advocate substitution with symbolic (spiritual, appropriate representation of five elements) objects if natural environment or object/s is/are not available or viable)

Pierce Method of Feng Shui (Sometimes Pronounced: Von Shway) The practice of melding striking with soothing furniture arrangements to promote peace and prosperity

After Richard Nixon's visit to the People's Republic of China in 1972, feng shui became popular in the United States. Critics, however, warn that attempts to prove its power scientifically have shown that it is a pseudoscience. Others charge that it has been reinvented and commercialized by New Age entrepreneurs or are concerned that much of the traditional theory has been lost in translation, not paid proper consideration, frowned upon, or even scorned.

Feng shui, however, has nonetheless found many uses. Landscape ecologists often find traditional feng shui an interesting study. In many cases, the only remaining patches of Asian old forest are "feng shui woods", associated with cultural heritage, historical continuity, and the preservation of various flora and fauna species. Some researchers interpret the presence of these woods as indicators that the "healthy homes", sustainability and environmental components of traditional feng shui should not be easily dismissed. Environmental scientists and landscape architects have researched traditional feng shui and its methodologies. Architects study feng shui as an Asian architectural tradition. Geographers have analyzed the techniques and methods to help locate historical sites in Victoria, British Columbia, Canada, and archaeological sites in the American Southwest, concluding that Native Americans also considered astronomy and landscape features.

Believers use it for healing purposes though there is no empirical evidence that it is in any way effective, to guide their businesses, or create a peaceful atmosphere in their homes. In particular, they use feng shui in the bedroom, where a number of techniques involving colors and arrangement achieve comfort and peaceful sleep. Some users of feng shui may be trying to gain a sense of security or control, such as by choosing auspicious numbers for their phones or Contemporary uses of traditional feng shui

A modern "feng shui fountain" at Taipei 101, Taiwan favorable house locations. Their motivation is similar to the reasons that some people consult fortune-tellers.

In 2005, Hong Kong Disneyland acknowledged feng shui as an important part of Chinese culture by shifting the main gate by twelve degrees in their building plans. This was among actions suggested by the planner of architecture and design at Walt Disney Imagineering, Wing Chao.

At Singapore Polytechnic and other institutions, professionals including engineers, architects, property agents and interior designers, take courses on feng shui and divination every year, a number of whom becoming part-time or full-time feng shui consultants.

TRADITIONAL FENG SHUI

Matteo Ricci (1552�1610), one of the founding fathers of Jesuit China missions, may have been the first European to write about feng shui practices. His account in De Christiana expedition apud Sinas tells about feng shui masters (geologi, in Latin) studying prospective construction sites or grave sites "with reference to the head and the tail and the feet of the particular dragons which are supposed to dwell beneath that spot". As a Catholic missionary, Ricci strongly criticized the "recondite science" of geomancy along with astrology as yet another superstitio absurdissima of the heathens: "What could be more absurd than their imagining that the safety of a family, honors, and their entire existence must depend upon such trifles as a door being opened from one side or another, as rain falling into a courtyard from the right or from the left, a window opened here or there, or one roof being higher than another?"

Victorian-era commentators on feng shui were generally ethnocentric, and as such skeptical and derogatory of what they knew of feng shui. In 1896, at a meeting of the Educational Association of China, Rev. P. W. Pitcher railed at the "rottenness of the whole scheme of Chinese architecture," and urged fellow missionaries "to erect unabashedly Western edifices of several stories and with towering spires in order to destroy nonsense about fung-shuy".

CRITICISMS

After the founding of the People's Republic of China in 1949, feng shui was officially considered a "feudalistic superstitious practice" and a "social evil" according to the state's ideology and was discouraged and even banned outright at times. Feng shui remained popular in Hong Kong, and also in the Republic of China (Taiwan), where traditional culture was not suppressed.

During the Cultural Revolution (1966-1976) feng shui was classified as one of the so-called Four Olds that were to be wiped out. Feng shui practitioners were beaten and abused by Red Guards and their works burned. After the death of Mao Zedong and the end of the Cultural Revolution, the official attitude became more tolerant but restrictions on feng shui practice are still in place in today's China. It is illegal in the PRC today to register feng shui consultation as a business and similarly advertising feng shui practice is banned. There have been frequent crackdowns on feng shui practitioners on the grounds of "promoting feudalistic superstitions" such as one in Qingdao in early 2006 when the city's business and industrial administration office shut down an art gallery converted into a feng shui practice. Some officials who had consulted feng shui were terminated and expelled from the Communist Party.

In 21st century mainland China less than one-third of the population believe in feng shui, and the proportion of believers among young urban Chinese is said to be even lower. Chinese academics permitted to research feng shui are anthropologists or architects by profession, studying the history of feng shui or historical feng shui theories behind the design of heritage buildings. They include Cai Dafeng, Vice-President of Fudan University. Learning in order to practice feng shui is still somewhat considered taboo. Nevertheless, it is reported that feng shui has gained adherents among Communist Party officials according to a BBC Chinese news commentary in 2006, and since the beginning of Chinese economic reforms the number of feng shui practitioners is increasing.

CONTEMPORARY FENG SHUI

SYCEE-SHAPED INCENSE USED IN FENG SHUI

One critic called the situation of feng shui in today's world "ludicrous and confusing," asking "Do we really believe that mirrors and flutes are going to change people's tendencies in any lasting and meaningful way?" He called for much further study or "we will all go down the tubes because of our inability to match our exaggerated claims with lasting changes." Robert T.

Carroll sums up the charges:

...feng shui has become an aspect of interior decorating in the Western world and alleged masters of feng shui now hire themselves out for hefty sums to tell people such as Donald Trump which way his doors and other things should hang. Feng shui has also become another New Age "energy" scam with arrays of metaphysical products...offered for sale to help you improve your health, maximize your potential, and guarantee fulfillment of some fortune cookie philosophy.

Skeptics charge that evidence for its effectiveness is based primarily upon anecdote and users are often offered conflicting advice from different practitioners, though feng shui practitioners use these differences as evidence of variations in practice or different branches of thought. A critical analyst concluded that "Feng shui has always been based upon mere guesswork".

Another objection was to the compass, a traditional tool for choosing favorable locations for property or burials. Critics point out that the compass degrees are often inaccurate because solar winds disturb the electromagnetic field of the earth. Magnetic North on the compass will be inaccurate because true magnetic north fluctuates.

The American magicians Penn and Teller dedicated an episode of their Bullshit! television show to criticize the acceptance of feng shui in the Western world as science. They devised a test in which the same dwelling was visited by five different feng shui consultants: each produced a different opinion about the dwelling, showing there is no consistency in the professional practice of feng shui.

Feng shui is criticized by Christians around the world. Some have argued that it is "entirely inconsistent with Christianity to believe that harmony and balance result from the manipulation and channeling of nonphysical forces or energies, or that such can be done by means of the proper placement of physical objects. Such techniques, in fact, belong to the world of sorcery.

Feng shui practitioners in China have found officials that are considered superstitious and corrupt easily interested, despite official disapproval. In one instance, in 2009, county officials in Gansu, on the advice of feng shui practitioners, spent $732,000 to haul a 369-ton "spirit rock" to the county seat to ward off "bad luck". Feng shui may require social influence or money because experts, architecture or design changes, and moving from place to place is expensive.

Less influential or less wealthy people lose faith in feng shui, saying that it is a game only for the wealthy. Others, however, practice less expensive forms of feng shui, including hanging special (but cheap) mirrors, forks, or woks in doorways to deflect negative energy.

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1.2.3.4 Qigong ^w

Qigong (/ˈtʃiːˈɡɒŋ/), qi gong, chi kung, chi 'ung, or chi gung (simplified Chinese: 气功; traditional Chinese: 氣功; pinyin: q�gōng; Wade�Giles: ch�i kung; lit. 'life-energy cultivation') is a system of coordinated body-posture and movement, breathing, and meditation used for the purposes of health, spirituality, and martial-arts training. With roots in Chinese medicine, philosophy, and martial arts, qigong is traditionally viewed by the Chinese and throughout Asia as a practice to cultivate and balance qi (pronounced approximately as "chi" or "chee"), translated as "life energy".

Qigong

Qigong practitioners at World Tai Chi and Qigong Day event in Manhattan.

Chinese name

Traditional Chinese �� 氣功

Simplified Chinese �� 气功

Transcriptions

Standard Mandarin

Hanyu Pinyin �� q�gōng

Wade�Giles �� ch�i kung

Tongyong Pinyin �� c�gōng

Yale Romanization �� ch�gūng

IPA �� [tɕʰîkʊ́ŋ]

Romanization �� chi去 khon平

Yue: Cantonese

Yale Romanization �� hei gūng

Jyutping �� hei3 gung1

IPA �� [hēi.kʊ́ŋ]

Southern Min

Hokkien POJ �� kh�-kong

Qigong practice typically involves moving meditation, coordinating slow-flowing movement, deep rhythmic breathing, and a calm meditative state of mind. People practice qigong throughout China and worldwide for recreation, exercise, relaxation, preventive medicine, self-healing, alternative medicine, meditation, self-cultivation, and training for martial arts.

Qigong (Pinyin), ch'i kung (Wade-Giles), and chi gung (Yale) are Romanized words for two Chinese characters: q� (气／氣) and gōng (功).

Qi (or chi) primarily means air, gas or breath but is often translated as a metaphysical concept of 'vital energy', referring to a supposed energy circulating through the body; though a more general definition is universal energy, including heat, light, and electromagnetic energy; and definitions often involve breath, air, gas, or the relationship between matter, energy, and spirit.

Qi is the central underlying principle in traditional Chinese medicine and martial arts. Gong (or kung) is often translated as cultivation or work, and definitions include practice, skill, mastery, merit, achievement, service, result, or accomplishment, and is often used to mean gongfu (kung fu) in the traditional sense of achievement through great effort. The two words are combined to describe systems to cultivate and balance life energy, especially for health and wellbeing.

Etymology

The term qigong as currently used was promoted in the late 1940s through the 1950s to refer to a broad range of Chinese self-cultivation exercises, and to emphasize health and scientific approaches, while de-emphasizing spiritual practices, mysticism, and elite lineages.

With roots in ancient Chinese culture dating back more than 4,000 years, a wide variety of qigong forms have developed within different segments of Chinese society: in traditional Chinese medicine for preventive and curative functions; in Confucianism to promote longevity and improve moral character; in Daoism and Buddhism as part of meditative practice; and in Chinese martial arts to enhance self defending abilities. Contemporary qigong blends diverse and sometimes disparate traditions, in particular the Daoist meditative practice of "internal alchemy" (Neidan 內丹術), the ancient meditative practices of "circulating qi" (Xing qi 行氣) and "standing meditation" (Zhan zhuang 站桩), and the slow gymnastic breathing exercise of "guiding and pulling" (Dao yin 導引). Traditionally, qigong was taught by master to students through training and oral transmission, with an emphasis on meditative practice by scholars and gymnastic or dynamic practice by the working masses.

�

The physical exercise chart; a painting on silk depicting the practice of Qigong Taiji; unearthed in 1973 in Hunan Province, China, from the 2nd-century BC Western Han burial site of Mawangdui Han tombs site, Tomb Number 3.

Starting in the late 1940s and the 1950s, the mainland Chinese government tried to integrate disparate qigong approaches into one coherent system, with the intention of establishing a firm scientific basis for qigong practice. In 1949, Liu Guizhen established the name "Qigong" to refer to the system of life-preserving practices that he and his associates developed, based on Dao yin and other philosophical traditions. This attempt is considered by some sinologists as the start of the modern or scientific interpretation of qigong. During the Great Leap Forward (1958�1963) and the Cultural Revolution (1966�1976), qigong, along with other traditional Chinese medicine, was under tight control with limited access among the general public, but was encouraged in state-run rehabilitation centers and spread to universities and hospitals.

After the Cultural Revolution, qigong, along with t'ai chi, was popularized as daily morning exercise practiced en masse throughout China.

Popularity of qigong grew rapidly during the Deng and Jiang eras after Mao Zedong's death in 1976 through the 1990s, with estimates of between 60 and 200 million practitioners throughout China. Along with popularity and state sanction came controversy and problems: claims of extraordinary abilities bordering on the supernatural, pseudoscience explanations to build credibility, a mental condition labeled qigong deviation, formation of cults, and exaggeration of claims by masters for personal benefit. In 1985, the state-run National Qigong Science and Research Organization was established to regulate the nation's qigong denominations. In 1999, in response to widespread revival of old traditions of spirituality, morality, and mysticism, and perceived challenges to State control, the Chinese government took measures to enforce control of public qigong practice, including shutting down qigong clinics and hospitals, and banning groups such as Zhong Gong and Falun Gong.: 161�174

Since the 1999 crackdown, qigong research and practice have only been officially supported in the context of health and traditional Chinese medicine. The Chinese Health Qigong Association, established in 2000, strictly regulates public qigong practice, with limitation of public gatherings, requirement of state approved training and certification of instructors, and restriction of practice to stateapproved forms.

Through the forces of migration of the Chinese diaspora, tourism in China, and globalization, the practice of qigong spread from the Chinese community to the world. Today, millions of people around the world practice qigong and believe in the benefits of qigong to varying degrees. Similar to its historical origin, those interested in qigong come from diverse backgrounds and practice it for different reasons, including for recreation, exercise, relaxation, preventive medicine, selfhealing, alternative medicine, self-cultivation, meditation, spirituality, and martial arts training.

PRACTICES

OVERVIEW

Qigong comprises a diverse set of practices that coordinate body (調身), breath (調息), and mind (調心) based on Chinese philosophy. Practices include moving and still meditation, massage, chanting, sound meditation, and non-contact treatments, performed in a broad array of body postures. Qigong is commonly classified into two foundational categories: 1) dynamic or active qigong (dong gong), with slow flowing movement; and 2) meditative or passive qigong (jing gong), with still positions and inner movement of the breath.: 21770�21772 From a therapeutic perspective, qigong can be classified into two systems:

1) internal qigong, which focuses on self-care and self-cultivation, and;

2) external qigong, which involves treatment by a therapist who directs or transmits qi.: 21777�21781

As moving meditation, qigong practice typically coordinates slow stylized movement, deep diaphragmatic breathing, and calm mental focus, with visualization of guiding qi through the body. While implementation details vary, generally qigong forms can be characterized as a mix of four types of practice: dynamic, static, meditative, and activities requiring external aids.

Dynamic practice involves fluid movement, usually carefully choreographed, coordinated with breath and awareness. Examples include the slow stylized movements of T'ai chi ch'uan, Baguazhang, and Xing Yi Quan. Other examples include graceful movement that mimics the motion of animals in Five Animals (Wu Qin Xi qigong), White Crane, and Wild Goose (Dayan) Qigong. As a form of gentle exercise, qigong is composed of movements that are typically repeated, strengthening and stretching the body, increasing fluid movement (blood, synovial, and lymph), enhancing balance and proprioception, and improving the awareness of how the body moves through space.

Static practice involves holding postures for sustained periods of time. In some cases, this bears resemblance to the practice of Yoga and its continuation in the Buddhist tradition. For example, Yiquan, a Chinese martial art derived from xingyiquan, emphasizes static stance training. In another example, the healing form Eight Pieces of Brocade (Baduanjin qigong) is based on a series of static postures.

Meditative practice utilizes breath awareness, visualization, mantra, chanting, sound, and focus on philosophical concepts such as qi circulation, aesthetics, or moral values. In traditional Chinese medicine and Daoist practice, the meditative focus is commonly on cultivating qi in dantian energy centers and balancing qi flow in meridian and other pathways. In various Buddhist traditions, the aim is to still the mind, either through outward focus, for example on a place, or through inward focus on the breath, a mantra, a koan, emptiness, or the idea of the eternal. In the Confucius scholar tradition, meditation is focused on humanity and virtue, with the aim of selfenlightenment.

USE OF EXTERNAL AGENTS

Many systems of qigong practice include the use of external agents such as ingestion of herbs, massage, physical manipulation, or interaction with other living organisms. For example, specialized food and drinks are used in some medical and Daoist forms, whereas massage and body manipulation are sometimes used in martial arts forms. In some medical systems a qigong master uses non-contact treatment, purportedly guiding qi through his or her own body into the body of another person.

FORMS

There are numerous qigong forms. 75 ancient forms that can be found in ancient literature and also 56 common or contemporary forms have been described in a qigong compendium.: 203�433 The list is by no means exhaustive. Many contemporary forms were developed by people who had recovered from their illness after qigong practice.

Most of the qigong forms come under the following categories:

1. Medical qigong

2. Martial qigong

3. Spiritual qigong

4. Intellectual qigong

5. Life nourishing qigong

Development of "health qigong"

In 1995, there was Qigong Talent Bank, an organization of Science Research of Chinese Qigong, functioning as network system of the senior Chinese qigong talents in China. In order to promote qigong exercises in a standardised and effective way with a scientific approach, The Chinese Health Qigong Association (CHQA) appointed panels of Qigong experts, Chinese medicine doctors and sport science professors from different hospitals, universities and qigong lineage across China to research and develop new sets of qigong exercises. In 2003 the CHQA officially promoted a new system called "health qigong", which consisted of four newly developed health qigong forms:

Health Qigong Muscle-Tendon Change Classic (Health Qigong Y� Jīn Jīng 易筋經).

Health Qigong Five Animals Frolics (Health qigong Wu Qin Xi 五禽戲).

Health Qigong Six Healing Sounds (Health Qigong Liu Zi Jue 六字訣).

Health Qigong Eight Pieces of Brocade (Health Qigong Ba Duan Jin 八段錦).

In 2010, the Chinese Health Qigong Association officially introduced five additional health qigong forms:

Health Qigong Tai Chi Yang Sheng Zhang (太極養生杖): a tai chi form from the stick tradition.

Health Qigong Shi Er Duan Jin (十二段錦): seated exercises to strengthen the neck, shoulders, waist, and legs.

Health Qigong Daoyin Yang Sheng Gong Shi Er Fa (導引養生功十二法): 12 routines from Daoyin tradition of guiding and pulling qi.

Health Qigong Mawangdui Daoyin (馬王堆導引术): guiding qi along the meridians with synchronous movement and awareness.

Health Qigong Da Wu (大舞): choreographed exercises to lubricate joints and guide qi.

Other commonly practised qigong styles and forms include:

Soaring Crane Qigong

Wisdom Healing Qigong

Pan Gu Mystical Qigong

Wild Goose (Dayan) Qigong

Dragon and Tiger Qigong

Primordial Qigong (Wujigong)

Chilel Qigong

Phoenix Qigong

Yuan Qigong

Zhong Yuan Qigong

TECHNIQUES

Whether viewed from the perspective of exercise, health, philosophy, or martial arts training, several main principles emerge concerning the practice of qigong:

Intentional movement: careful, flowing balanced style Rhythmic breathing: slow, deep, coordinated with fluid movement

Awareness: calm, focused meditative state

Visualization: of qi flow, philosophical tenets, aesthetics

Chanting/Sound: use of sound as a focal point

Additional principles:

Softness: soft gaze, expressionless face

Solid Stance: firm footing, erect spine

Relaxation: relaxed muscles, slightly bent joints

Balance and Counterbalance: motion over the center of gravity

Advanced goals:

Equanimity: more fluid, more relaxed

Tranquility: empty mind, high awareness

Stillness: smaller and smaller movements, eventually to complete stillness

The most advanced practice is generally considered to be with little or no motion.

TRADITIONAL AND CLASSICAL THEORY

Qigong practitioners in Brazil

Over time, five distinct traditions or schools of qigong developed in China, each with its own theories and characteristics: Chinese Medical Qigong, Daoist Qigong, Buddhist Qigong, Confucian Qigong, and Martial Qigong.: 30�80 All of these qigong traditions include practices intended to cultivate and balance qi.

TRADITIONAL CHINESE MEDICINE

The theories of ancient Chinese qigong include the Yin-Yang and Five Phases Theory, Essence-Qi-Spirit Theory, Zang-Xiang Theory, and Meridians and Qi-Blood Theory, which have been synthesized as part of Traditional Chinese Medicine (TCM).: 45�57 TCM focuses on tracing and correcting underlying disharmony, in terms of deficiency and excess, using the complementary and opposing forces of yin and yang (陰陽), to create a balanced flow of qi. Qi is believed to be cultivated and stored in three main dantian energy centers and to travel through the body along twelve main meridians (Jīng Lu� 經絡), with numerous smaller branches and tributaries. The main meridians correspond to twelve main organs ) (Z�ng fǔ 臟腑). Qi is balanced in terms of yin and yang in the context of the traditional system of Five Phases (Wu xing 五行). A person is believed to become ill or die when qi becomes diminished or unbalanced. Health is believed to be returned by rebuilding qi, eliminating qi blockages, and correcting qi imbalances. These TCM concepts do not translate readily to modern science and medicine.

Daoism

In Daoism, various practices now known as Daoist qigong are claimed to provide a way to achieve longevity and spiritual enlightenment, as well as a closer connection with the natural world.

Buddhism

In Buddhism meditative practices now known as Buddhist qigong are part of a spiritual path that leads to spiritual enlightenment or Buddhahood.

Confucianism

In Confucianism practices now known as Confucian qigong provide a means to become a Junzi (君子) through awareness of morality.

In contemporary China, the emphasis of qigong practice has shifted away from traditional philosophy, spiritual attainment, and folklore, and increasingly to health benefits, traditional medicine and martial arts applications, and a scientific perspective. Qigong is now practiced by millions worldwide, primarily for its health benefits, though many practitioners have also adopted traditional philosophical, medical, or martial arts perspectives, and even use the long history of qigong as evidence of its effectiveness.

CONTEMPORARY CHINESE MEDICAL QIGONG

Qigong has been recognized as a "standard medical technique" in China since 1989, and is sometimes included in the medical curriculum of major universities in China.: 34 The 2013 English translation of the official Chinese Medical Qigong textbook used in China: iv, 385 defines CMQ as "the skill of body-mind exercise that integrates body, breath, and mind adjustments into one" and emphasizes that qigong is based on "adjustment" (tiao 調, also translated as "regulation", "tuning", or "alignment") of body, breath, and mind.: 16�18 As such, qigong is viewed by practitioners as being more than common physical exercise, because qigong combines postural, breathing, and mental training in one to produce a particular psychophysiological state of being.: 15 While CMQ is still based on traditional and classical theory, modern practitioners also emphasize the importance of a strong scientific basis.: 81�89

According to the 2013 CMQ textbook, physiological effects of qigong are numerous, and include improvement of respiratory and cardiovascular function, and possibly neurophysiological function.: 89�102

CONVENTIONAL MEDICINE

Especially since the 1990s, conventional or mainstream Western medicine often strives to heed the model of evidence-based medicine, EBM, which demotes medical theory, clinical experience, and physiological data to prioritize the results of controlled, and especially randomized, clinical trials of the treatment itself. Although some clinical trials support qigong's effectiveness in treating conditions diagnosed in Western medicine, the quality of these studies is mostly low and, overall, their results are mixed.

Integrative, complementary, and alternative medicine

CONTEMPORARY QIGONG

Integrative medicine (IM) refers to "the blending of conventional and complementary medicines and therapies with the aim of using the most appropriate of either or both modalities to care for the patient as a whole",: 455�456 whereas complementary is using a non-mainstream approach together with conventional medicine, while alternative is using a non-mainstream approach in place of conventional medicine. Qigong is used by integrative medicine practitioners to complement conventional medical treatment, based on complementary and alternative medicine interpretations of the effectiveness and safety of qigong.: 22278�22306

SCIENTIFIC BASIS

Scientists interested in qigong have sought to describe or verify the effects of qigong, to explore mechanisms of effects, to form scientific theory with respect to qigong, and to identify appropriate research methodology for further study.: 81�89 In terms of traditional theory, the existence of qi has not been independently verified in an experimental setting. In any case, some researches have reported effects on pathophysiological parameters of biomedical interest.

RECREATION AND POPULAR USE

People practice qigong for many different reasons, including for recreation, exercise and relaxation, preventive medicine and self-healing, meditation and self-cultivation, and training for martial arts. Practitioners range from athletes to people with disabilities. Because it is low impact and can be done lying, sitting, or standing, qigong is accessible for people with disabilities, seniors, and people recovering from injuries.

THERAPEUTIC USE

Therapeutic use of qigong is directed by TCM, CAM, integrative medicine, and other health practitioners. In China, where it is considered a "standard medical technique",: 34 qigong is commonly prescribed to treat a wide variety of conditions, and clinical applications include hypertension, coronary artery disease, peptic ulcers, chronic liver diseases, diabetes mellitus, obesity, menopause syndrome, chronic fatigue syndrome, insomnia, tumors and cancer, lower

Practitioners, uses and cautions back and leg pain, cervical spondylosis, and myopia.: 261�391 Outside China qigong is used in integrative medicine to complement or supplement accepted medical treatments, including for relaxation, fitness, rehabilitation, and treatment of specific conditions. However, there is no high-quality evidence that qigong is actually effective for these conditions. Based on systematic reviews of clinical research, there is insufficient evidence for the effectiveness of using qigong as a therapy for any medical condition.

SAFETY AND COST

Qigong is generally viewed as safe. No adverse effects have been observed in clinical trials, such that qigong is considered safe for use across diverse populations. Cost for self-care is minimal, and cost efficiencies are high for group delivered care. Typically, the cautions associated with qigong are the same as those associated with any physical activity, including risk of muscle strains or sprains, advisability of stretching to prevent injury, general safety for use alongside conventional medical treatments, and consulting with a physician when combining with conventional treatment.

OVERVIEW

Although there is ongoing clinical research examining the potential health effects of qigong, there is little financial or medical incentive to support high-quality research, and still only a limited number of studies meet accepted medical and scientific standards of randomized controlled trials (RCTs). Clinical research concerning qigong has been conducted for a wide range of medical conditions, including bone density, cardiopulmonary effects, physical function, falls and related risk factors, quality of life, immune function, inflammation, hypertension, pain, and cancer treatment.

SYSTEMATIC REVIEWS

A 2009 systematic review on the effect of qigong exercises on reducing pain concluded that "the existing trial evidence is not convincing enough to suggest that internal qigong is an effective modality for pain management."

CLINICAL RESEARCH

A 2010 systematic review of the effect of qigong exercises on cancer treatment concluded "the effectiveness of qigong in cancer care is not yet supported by the evidence from rigorous clinical trials." A separate systematic review that looked at the effects of qigong exercises on various physiological or psychological outcomes found that the available studies were poorly designed, with a high risk of bias in the results. Therefore, the authors concluded, "Due to limited number of RCTs in the field and methodological problems and high risk of bias in the included studies, it is still too early to reach a conclusion about the efficacy and the effectiveness of qigong exercise as a form of health practice adopted by the cancer patients during their curative, palliative, and rehabilitative phases of the cancer journey."

A 2011 overview of systematic reviews of controlled clinical trials, Lee et al. concluded that "the effectiveness of qigong is based mostly on poor quality research" and "therefore, it would be unwise to draw firm conclusions at this stage." Although a 2010 comprehensive literature review found 77 peer-reviewed RCTs, Lee et al.'s overview of systematic reviews as to particular health conditions found problems like sample size, lack of proper control groups, with lack of blinding associated with high risk of bias.

A 2015 systematic review of the effect of qigong exercises on cardiovascular diseases and hypertension found no conclusive evidence for effect. Also in 2015, a systemic review into the effects on hypertension suggested that it may be effective, but that the evidence was not conclusive because of the poor quality of the trials it included, and advised more rigorous research in the future. Another 2015 systematic review of qigong on biomarkers of cardiovascular disease concluded that some trials showed favorable effects, but concludes, "Most of the trials included in this review are likely to be at high risk of bias, so we have very low confidence in the validity of the results.

MENTAL HEALTH

Many claims have been made that qigong can benefit or ameliorate mental health conditions, including improved mood, decreased stress reaction, and decreased anxiety and depression.

Most medical studies have only examined psychological factors as secondary goals, although various studies have shown decreases in cortisol levels, a chemical hormone produced by the body in response to stress.

China

Basic and clinical research in China during the 1980s was mostly descriptive, and few results were reported in peer-reviewed English-language journals.: 22060�22063 Qigong became known outside China in the 1990s, and clinical randomized controlled trials investigating the effectiveness of qigong on health and mental conditions began to be published worldwide, along with systematic reviews.: 21792�21798

CHALLENGES

Most existing clinical trials have small sample sizes and many have inadequate controls. Of particular concern is the impracticality of double blinding using appropriate sham treatments, and the difficulty of placebo control, such that benefits often cannot be distinguished from the placebo effect.: 22278�22306� Also of concern is the choice of which qigong form to use and how to standardize the treatment or amount with respect to the skill of the practitioner leading or administering treatment, the tradition of individualization of treatments, and the treatment length, intensity, and frequency.: 6869�6920, 22361�22370

Qigong is practiced for meditation and self-cultivation as part of various philosophical and spiritual traditions. As meditation, qigong is a means to still the mind and enter a state of consciousness that brings serenity, clarity, and bliss. Many practitioners find qigong, with its gentle focused movement, to be more accessible than seated meditation.

Qigong for self-cultivation can be classified in terms of traditional Chinese philosophy: Daoist, Buddhist, and Confucian. The practice of qigong is an important component in both internal and external style Chinese martial arts. Focus on qi is considered to be a source of power as well as the foundation of the internal style of martial arts (Neijia). T'ai Chi Ch'uan, Xing Yi Quan, and Baguazhang are representative of the types of Chinese martial arts that rely on the concept of qi as the foundation. Extraordinary feats of martial arts prowess, such as the ability to withstand heavy strikes (Iron Shirt, 鐵衫) and the ability to break hard objects (Iron Palm, 鐵掌) are abilities attributed to qigong training.

MEDITATION AND SELF-CULTIVATION APPLICATIONS

Martial arts applications

T'ai Chi Ch'uan and qigong

T'ai Chi Ch'uan (Taijiquan) is a widely practiced Chinese internal martial style based on the theory of taiji, closely associated with qigong, and typically involving more complex choreographed movement coordinated with breath, done slowly for health and training, or quickly for selfdefense.

Many scholars consider t'ai chi ch'uan to be a type of qigong, traced back to an origin in the seventeenth century. In modern practice, qigong typically focuses more on health and meditation rather than martial applications, and plays an important role in training for t'ai chi ch'uan, in particular used to build strength, develop breath control, and increase vitality ("life energy").

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1.2.3.5 Reflexology ^w

Reflexology, also known as zone therapy, is an alternative medical practice involving the application of pressure to specific points on the feet, ears, and/or hands. This is done using thumb, finger, and hand massage techniques without the use of oil or lotion. It is based on a pseudoscientific system of zones and reflex areas that purportedly reflect an image of the body on the feet and hands, with the premise that such work on the feet and hands causes a physical change to the supposedly related areas of the body.

History

Practices resembling reflexology may have existed in previous historical periods. Similar practices have been documented in the histories of India, China and Egypt. Reflexology was introduced to the United States in 1913 by William H. Fitzgerald, M.D. (1872�1942), an ear, nose, and throat specialist, and Edwin F. Bowers. Fitzgerald claimed that applying pressure had an anesthetic effect on other areas of the body. It was modified in the 1930s and 1940s by Eunice D. Ingham (1889�1974), a nurse and physiotherapist. Ingham claimed that the feet and hands were especially sensitive, and mapped the entire body into "reflexes" on the feet, renaming "zone therapy" reflexology. Many of the modern reflexologists use Ingham's methods, or similar techniques of reflexologist Laura Norman.

In 2015 the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; reflexology was one of 17 therapies evaluated for which no clear evidence of effectiveness was found. Accordingly, in 2017, the Australian government named reflexology as a practice that would not qualify for insurance subsidy, saying this step would "ensure taxpayer funds are expended appropriately and not directed to therapies lacking evidence".

1.2.3.6 Shiatsu ^w

Shiatsu (/ʃiˈ�ts-, -ˈɑːtsuː/ shee-AT-, -⁠AHT-soo; 指圧) is a form of Japanese bodywork based on pseudoscientific concepts in traditional Chinese medicine such as qi meridians. Having been popularized in the twentieth century by Tokujiro Namikoshi (1905�2000), shiatsu derives from the older Japanese massage modality called anma.

Shiatsu

"Shiatsu" in new-style (shinjitai) kanji

Japanese name

Shinjitai �� 指圧

Transcriptions

Romanization �� Shiatsu

There is no scientific evidence that shiatsu will prevent or cure any disease. Although it is considered a generally safe treatment�if sometimes painful�there have been reports of adverse health effects arising from its use, a few of them serious.

Description

In the Japanese language, shiatsu means "finger pressure". Shiatsu techniques include massages with fingers, thumbs, feet and palms; acupressure, assisted stretching; and joint manipulation and mobilization. To examine a patient, a shiatsu practitioner uses palpation and, sometimes, pulse diagnosis.

The Japanese Ministry of Health defines shiatsu as "a form of manipulation by thumbs, fingers and palms without the use of instruments, mechanical or otherwise, to apply pressure to the human skin to correct internal malfunctions, promote and maintain health, and treat specific diseases. The techniques used in shiatsu include stretching, holding, and most commonly, leaning body weight into various points along key channels."

The practice of shiatsu is based on the traditional Chinese concept of qi, which is sometimes described as an "energy flow". Qi is supposedly channeled through certain pathways in the human body, known as meridians, causing a variety of effects. Despite the fact that many practitioners use these ideas in explaining shiatsu, neither qi nor meridians exist as observable phenomena.

Efficacy

There is no evidence that shiatsu is of any benefit in treating cancer or any other disease, though some evidence suggests it might help people feel more relaxed. In 2015, the Australian Government's Department of Health published the results of a review of alternative therapies that sought to determine if any were suitable for being covered by health insurance; shiatsu was one of 17 therapies evaluated for which no clear evidence of effectiveness was found.

Accordingly, in 2017, the Australian government named shiatsu as a practice that would not qualify for insurance subsidy, to ensure the best use of insurance funds.

History

�

Shiatsu practitioners believe that an energy called ki flows through a network of meridians in the body.

Shiatsu's claims of having a positive impact on a recipient's sense of vitality and well-being have to some extent been supported by studies where recipients reported improved relaxation, sleep, and lessened symptom severity. However, the state of the evidence on its efficacy for treating any malady is poor, and one recent systematic review did not find shiatsu to be effective for any particular health condition. It is generally considered safe, though some studies have reported negative effects after a treatment with shiatsu, and examples of serious health complications exist including one case of thrombosis, one embolism, and a documented injury from a "shiatsutype massaging machine".

Shiatsu evolved from anma, a Japanese style of massage developed in 1320 by Akashi Kan Ichi. Anma was popularised in the seventeenth century by acupuncturist Sugiyama Waichi, and around the same time the first books on the subject, including Fujibayashi Ryohaku's Anma Tebiki ("Manual of Anma"), appeared.

�

Introduction page, Anma Tebiki

The Fujibayashi school carried anma into the modern age. Prior to the emergence of shiatsu in Japan, masseurs were often nomadic, earning their keep in mobile massage capacities, and paying commissions to their referrers.

Since Sugiyama's time, massage in Japan had been strongly associated with the blind.

Sugiyama, blind himself, established a number of medical schools for the blind which taught this practice. During the Tokugawa period, edicts were passed which made the practice of anma solely the preserve of the blind � sighted people were prohibited from practicing the art. As a result, the "blind anma" has become a popular trope in Japanese culture. This has continued into the modern era, with a large proportion of the Japanese blind community continuing to work in the profession.

Abdominal palpation as a Japanese diagnostic technique was developed by Shinsai Ota in the 17th century.

During the Occupation of Japan by the Allies after World War II, traditional medicine practices were banned (along with other aspects of traditional Japanese culture) by General MacArthur.

The ban prevented a large proportion of Japan's blind community from earning a living. Many Japanese entreated for this ban to be rescinded. Additionally, writer and advocate for blind rights Helen Keller, on being made aware of the prohibition, interceded with the United States government; at her urging, the ban was rescinded.

Tokujiro Namikoshi (1905�2000) founded his shiatsu college in the 1940s and his legacy was the state recognition of shiatsu as an independent method of treatment in Japan. He is often credited with inventing modern shiatsu. However, the term shiatsu was already in use in 1919, when a book called Shiatsu Ho ("finger pressure method") was published by Tamai Tempaku.

Also prior to Namikoshi's system, in 1925 the Shiatsu Therapists Association was founded, with the purpose of distancing shiatsu from anma massage.

Namikoshi's school taught shiatsu within a framework of western medical science. A student and teacher of Namikoshi's school, Shizuto Masunaga, brought shiatsu back to traditional eastern medicine and philosophic framework. Masunaga grew up in a family of shiatsu practitioners, with his mother having studied with Tamai Tempaku. He founded Zen Shiatsu and the Iokai Shiatsu Center school. Another student of Namikoshi, Hiroshi Nozaki founded the Hiron Shiatsu, a holistic technique of shiatsu that uses intuitive techniques and a spiritual approach to healing which identifies ways how to take responsibility for a healthy and happy life in the practitioner's own hands. It is practiced mainly in Switzerland, France and Italy, where its founder opened several schools.

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1.2.4 Traditional Tibetan medicine ^w

Traditional Tibetan medicine (Tibetan: བོད་ཀྱི་གསོ་བ་རིག་པ་, Wylie: bod kyi gso ba rig pa), also known as Sowa-Rigpa medicine, is a centuries-old traditional medical system that employs a complex approach to diagnosis, incorporating techniques such as pulse analysis and urinalysis, and utilizes behavior and dietary modification, medicines composed of natural materials (e.g., herbs and minerals) and physical therapies (e.g. Tibetan acupuncture, moxabustion, etc.) to treat illness.

The Tibetan medical system is based upon Indian Buddhist literature (for example Abhidharma and Vajrayana tantras) and Ayurveda. It continues to be practiced in Tibet, India, Nepal, Bhutan, Ladakh, Siberia, China and Mongolia, as well as more recently in parts of Europe and North America. It embraces the traditional Buddhist belief that all illness ultimately results from the three poisons: delusion, greed and aversion. Tibetan medicine follows the Buddha's Four Noble Truths which apply medical diagnostic logic to suffering.

History

As Indian culture flooded Tibet in the eleventh and twelfth centuries, a number of Indian medical texts were also transmitted. For example, the Ayurvedic Astāngahrdayasamhitā (Heart of Medicine Compendium attributed to Vagbhata) was translated into Tibetan by རིན་ཆེན་བཟང་པོ། (Rinchen Zangpo) (957�1055). Tibet also absorbed the early Indian Abhidharma literature, for example the fifth-century Abhidharmakosasabhasyam by Vasubandhu, which expounds upon medical topics, such as fetal development. A wide range of Indian Vajrayana tantras, containing practices based on medical anatomy, were subsequently absorbed into Tibet.

Some scholars believe that rgyud bzhi (the Four Tantras) was told by the Buddha, while some believe it is the primary work of གཡུ་ཐོག་ཡོན་ཏན་མགོན་པོ། (Yuthok Yontan Gonpo, 708 AD). The former opinion is often refuted by saying "If it was told by the Lord Buddha, rgyud bzhi should have a Sanskrit version". However, there is no such version and also no Indian practitioners who have received unbroken lineage of rgyud bzhi. Thus, the later thought should be scholarly considered authentic and practical. The provenance is uncertain.

It was the aboriginal Tibetan people's accumulative knowledge of their local plants and their various usages for benefiting people's health that were collected by སྟོན་པོ་གཤེན་རབ་མི་བོ་ཆེ། the Tonpa Shenrab Miwoche and passed down to one of his sons. Later Yuthok Yontan Gonpo perfected it and there was no author for the books, because at the time it was politically incorrect to mention anything related to Bon nor faith in it.

གཡུ་ཐོག་ཡོན་ཏན་མགོན་པོ། (Yuthok Yontan Gonpo) adapted and synthesized the Four Tantras in the 12th Century. The Four Tantras are scholarly debated as having Indian origins or, as Remedy Master Buddha Bhaisajyaguru's word or, as authentically Tibetan. It was not formally taught in schools at first but, intertwined with Tibetan Buddhism. Around the turn of the 14th century, the Drangti family of physicians established a curriculum for the Four Tantras (and the supplementary literature from the Yutok school) at ས་སྐྱ་དགོན། (Sakya Monastery). The ཏཱ་ལའི་བླ་ མ་སྐུ་ཕྲེང་ལྔ་བ། (5th Dalai Lama) supported སྡེ་སྲིད་སངས་རྒྱས་རྒྱ་མཚོ། (Desi Sangye Gyatso) to found the pioneering Chagpori College of Medicine in 1696. Chagpori taught Gyamtso's Blue Beryl as well as the Four Tantras in a model that spread throughout Tibet along with the oral tradition.

The Four Tantras (Gyuzhi, རྒྱུད་བཞི།) is a native Tibetan text incorporating Indian, Chinese and Greco-Arab medical systems. The Four Tantras is believed to have been created in the twelfth century and still today is considered the basis of Tibetan medical practise. The Four Tantras is the common name for the text of the Secret Tantra Instruction on the Eight Branches, the Immortality Elixir essence. It considers a single medical doctrine from four perspectives. Sage Vidyajnana expounded their manifestation. The basis of the Four Tantras is to keep the three bodily humors in balance; (wind rlung, bile mkhris pa, phlegm bad kan.)

Four Tantras

Root Tantra � A general outline of the principles of Tibetan medicine, it discusses the humors in the body and their imbalances and their link to illness. The Four Tantra uses visual observation to diagnose predominantly the analysis of the pulse, tongue and analysis of the urine (in modern terms known as urinalysis)

Exegetical Tantra � This section discusses in greater detail the theory behind the Four Tantras and gives general theory on subjects such as anatomy, physiology, psychopathology, embryology and treatment.

Instructional Tantra � The longest of the Tantras is mainly a practical application of treatment, it explains in detail illnesses and which humoral imbalance which causes the illness. This section also describes their specific treatments.

Subsequent Tantra � Diagnosis and therapies, including the preparation of Tibetan medicine and cleansing of the body internally and externally with the use of techniques such as moxibustion, massage and minor surgeries.

Some believe the Four Tantra to be the authentic teachings of the Buddha 'Master of remedies' which was translated from Sanskrit, others believe it to be solely Tibetan in creation by Yuthog the Elder or Yuthog the Younger. Noting these two theories there remain others sceptical as to its original author.

Believers in the Buddhist origin of the Four Tantras and how it came to be in Tibet believe it was first taught in India by the Buddha when he manifested as the 'Master of Remedies'. The Four Tantra was then in the eighth century translated and offered to Padmasambhava by Vairocana and concealed in Samye monastery. In the second half of the eleventh century it was rediscovered and in the following century it was in the hands of Yuthog the Younger who completed the Four Tantras and included elements of Tibetan medicine, which would explain why there is Indian elements to the Four Tantras.

Although there is clear written instruction in the Four Tantra, the oral transmission of medical knowledge still remained a strong element in Tibetan Medicine, for example oral instruction may have been needed to know how to perform a moxibustion technique.

Like other systems of traditional Asian medicine, and in contrast to biomedicine, Tibetan medicine first puts forth a specific definition of health in its theoretical texts. To have good health, Tibetan medical theory states that it is necessary to maintain balance in the body's three Three principles of function principles of function [often translated as humors]: rLung (pron. Loong), mKhris-pa (pron. Treepa) [often translated as bile], and Bad-kan (pron. Pay-gen) [often translated as phlegm].

� rLung is the source of the body's ability to circulate physical substances (e.g. blood), energy (e.g. nervous system impulses), and the non-physical (e.g. thoughts). In embryological development, the mind's expression of materialism is manifested as the system of rLung. There are five distinct subcategories of rLung each with specific locations and functions: Srog-'Dzin rL�ng, Gyen-rGyu rLung, Khyab-Byed rL�ng, Me-mNyam rLung, Thur-Sel rL�ng.

� mKhris-pa is characterized by the quantitative and qualitative characteristics of heat, and is the source of many functions such as thermoregulation, metabolism, liver function and discriminating intellect. In embryological development, the mind's expression of aggression is manifested as the system of mKhris-pa. There are five distinct subcategories of mKhris-pa each with specific locations and functions: 'Ju-Byed mKhris-pa, sGrub-Byed mKhris-pa, mDangs-sGyur mKhris-pa, mThong-Byed mKhris-pa, mDog-Sel mKhris-pa.

� Bad-kan is characterized by the quantitative and qualitative characteristics of cold, and is the source of many functions such as aspects of digestion, the maintenance of our physical structure, joint health and mental stability. In embryological development, the mind's expression of ignorance is manifested as the system of Bad-kan. There are five distinct subcategories of Bad-kan each with specific locations and functions: rTen-Byed Bad-kan, Myag-byed Bad-kan, Myong-Byed Bad-kan, Tsim-Byed Bad-kan, 'Byor-Byed Bad-kan.

Usage

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Center for Oriental Medicine. Ulan-Ude, Buryatia, Russia

A key objective of the government of Tibet is to promote traditional Tibetan medicine among the other ethnic groups in China. Once an esoteric monastic secret, the Tibet University of Traditional Tibetan Medicine and the Qinghai University Medical School now offer courses in the practice. In addition, Tibetologists from Tibet have traveled to European countries such as Spain to lecture on the topic.

The Tibetan government-in-exile has also kept up the practise of Tibetan Medicine in India since 1961 when it re-established the Men-Tsee-Khang (the Tibetan Medical and Astrological Institute). It now has 48 branch clinics in India and Nepal.

The Government of India has approved the establishment of the National Institute for Sowa-Rigpa (NISR) in Leh to provide opportunities for research and development of Sowa-Rigpa.

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1.2.5 Traditional Korean medicine ^w

Traditional Korean medicine (known in North Korea as Koryo medicine) refers to the forms of traditional medicine practiced in Korea.

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A Korean acupuncturist inserting a needle into the leg of a male patient. Wellcome Collection

Korean medicine traditions originated in ancient and prehistoric times and can be traced back as far as 3000 B.C. when stone and bone needles were found in North Hamgyong Province, in present-day North Korea. Korean medicine originated from China. In Gojoseon, where the founding myth of Korea is recorded, there is a story of a tiger and a bear who wanted to reincarnate in human form and who ate wormwood and garlic. In Jewang Ungi (제왕운기), which was written around the time of Samguk Yusa, wormwood and garlic are described as 'edible medicine', showing that, even in times when incantatory medicine was the mainstream, medicinal herbs were given as curatives in Korea. Medicinal herbs at this time were used as remedial treatment such as easing the pain or tending injury, along with knowing what foods were good for health.

In the period of the Three Kingdoms, traditional Korean medicine was mainly influenced by other traditional medicines such as ancient Chinese medicine. In the Goryeo dynasty, a more intense investigation of domestic herbs took place: The result was the publication of numerous books on domestic herbs. Medical theories at this time were based on the medicine of Song dynasty, but prescriptions were based on the medicine of the Unified Silla period such as the medical text First Aid Prescriptions Using Native Ingredients or Hyangyak Gugeupbang (향약구급방), which was published in 1236. Other medical journals were published during this period like Introductory

Guide to Medicine for the General Public or Jejungiphyobang (제중입효방).

Medicine flourished in the period of the Joseon. For example, the first training system of nurses was instituted under King Taejong (1400�1418), while under the reign of King Sejong the Great (1418�1450) measures were adopted to promote the development of a variety of Korean medicinal ingredients. These efforts were systematized and published in the Hyangyak Jipseongbang (향약집성방, 1433), which was completed and included 703 Korean native medicines, providing an impetus to break away from dependence on Chinese medicine. The medical encyclopaedia named Classified Collection of Medical Prescriptions (醫方類聚, 의방유취), which included many classics from traditional chinese medicine, written by Kim Ye-mong (金禮蒙, 김예몽) and other Korean official doctors from 1443 to 1445, was regarded as one of the greatest medical texts of the 15th century. It included more than 50,000 prescriptions and incorporated 153 different Korean and Chinese texts, including the Concise Prescriptions of Royal Doctors (御醫撮要方, 어의촬요방) which was written by Choi Chong-jun (崔宗峻, 최종준) in 1226. Classified Collection of Medical Prescriptions has very important research value, because it keeps the contents of many ancient Korean and Chinese medical books that had been lost for a long time.

After this, many books on medical specialties were published. There are three physicians from the Joseon Dynasty (1392�1910) who are generally credited with further development of traditional Korean medicine�Heo Jun, Saam, and Lee Je-ma. After the Japanese invasion in 1592, Dongeui Bogam (동의보감) was written by Heo Jun, the first of the major physicians. This work further integrated the Korean and Chinese medicine of its time and was influential to Chinese, Japanese and Vietnamese medicine.

The next major influence to traditional Korean medicine is related to Sasang typology (사상의학).

Lee Je-ma and his book, The Principal of Life Preservation in Oriental Medicine (東醫壽世保元, 동의수세보원) systematically theorized with the influence of Korean Confucianism and his clinical experiences in Korea. Lee Je-ma said that even if patients suffer the same illness, patients need to use different herbal applications to treat the same illness due to the pathophysiologies of individuals. He stresses that the health of human body had a close relationship with the state of mind. He believed that the human mind and body were not separate and they closely reflected each other, and the aspect of mind needed to be considered when examining the causes of disease. Thus, not only food and natural environment but also emotional changes in humans can be another major reason for illness. He believed that medical diagnosis and treatment should be based on person's typology rather than on symptoms alone and each person should be given different prescriptions depending on the constitution of the individual. Sasang typology (사상의학) focuses on the individual patients based on different reactions to disease and herbs. Treat illness by the treatment of the root cause through proper diagnosis. Key to this diagnosis is to first determine the internal organs or pathophysiology of each patient.

Dongui Bogam, National Museum of Korea

The next recognized individual is Saam, a priest-physician who is believed to have lived during the 16th century. Although there is much unknown about Saam, including his real name and date of birth, it is recorded that he studied under the famous monk Samyang. He developed a system of acupuncture that employs the five element theory.

In the late Joseon dynasty, positivism was widespread. Clinical evidence was used more commonly as the basis for studying disease and developing cures. Scholars who had turned away from politics devoted themselves to treating diseases and, in consequence, new schools of traditional medicine were established. Simple books on medicine for the common people were published.

Lee Je-ma classified human beings into four main types, based on the emotion that dominated their personality and developed treatments for each type:

Tae-Yang (태양, 太陽) or "greater yang"

So-Yang (소양, 小陽) or "lesser yang"

Tae-Eum (태음, 太陰) or "greater yin"

So-Eum (소음, 小陰) or "lesser yin"

A study focused on the examination of traditional Korean medicine during the Covid pandemic has concluded that "traditional Korean medicine homecare services could function as a viable alternative for continued medical care disrupted during the coronavirus disease 19 pandemic."

Methods

Herbal medicine

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hanyak (traditional medicine)

Herbalism is the study and practice of using plant material for the purpose of food, medicine, or health. They may be flowers, plants, shrubs, trees, moss, lichen, fern, algae, seaweed or fungus.

The plant may be used in its entirety or with only specific parts. In each culture or medical system there are different types of herbal practitioners: professional and lay herbalists, plant gatherers, and medicine makers.

Herbal medicines may be presented in many forms including fresh, dried, whole, or chopped.

Herbs may be prepared as infusions when an herb is soaked in a liquid or decocted�simmered in water over low heat for a certain period. Some examples of infusion are chamomile or peppermint, using flowers, leaves and powdered herbs. Decocting examples may be rose hips, cinnamon bark, and licorice root consisting of fruits, seeds, barks, and roots. Fresh and dried herbs can be tinctured where herbs are kept in alcohol or contained in a vinegar extract. They can be preserved as syrups such as glycerites in vegetable glycerin or put in honey known as miels. Powdered and freeze dried herbs can be found in bulk, tablets, troches similar to a lozenge, pastes, and capsules.

Non-oral herbal uses consist of creams, baths, oils, ointments, gels, distilled waters, washes, poultices, compresses, snuffs, steams, inhaled smoke and aromatics volatile oils.

Many herbalists consider the patient's direct involvement to be critical. These methods are delivered differently depending on the herbal traditions of each area. Nature is not necessarily safe; special attention should be used when grading quality, deciding a dosage, realizing possible effects, and any interactions with herbal medications.

An example of herbal medicine is the use of medicinal mushrooms as a food and as a tea. A notable mushroom used in traditional Korean medicine is Phellinus linteus known as Song-gen.

Acupuncture

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Doctor's office in folk village in premodern Korea.

Acupuncture is used to withdraw blood or stimulate certain points on humans and animals by inserting them on specific pressure points of the body. Traditional acupuncture involves the belief that a "life force" (qi) circulates within the body in lines called meridians. Scientific investigation has not found any histological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points, and many modern practitioners no longer support the existence of life force energy (qi) flowing through meridians, which was a major part of early belief systems. Pressure points can be stimulated through a mixture of methods ranging from the insertion and withdrawal of very small needles to the use of heat, known as moxibustion. Pressure points can also be stimulated by laser, massage, and electrical means.: 234

Moxibustion

Moxibustion is a technique in which heat is applied to the body with a stick or a cone of burning mugwort. The tool is placed over the affected area without burning the skin. The cone or stick can also be placed over a pressure point to stimulate and strengthen the blood.

A Cochrane Review found limited evidence for the use of moxibustion in correcting breech presentation of babies, and called for more experimental trials. Moxibustion has also been studied for the treatment of pain, cancer, stroke, ulcerative colitis, constipation, and hypertension. Systematic reviews have found that these studies are of low quality and positive findings could be due to publication bias.

Education

Graduate School of Korean Medicine

The South Korean government established a national school of traditional Korean medicine to establish its national treasure on a solid basis after the closing of the first modern educational facility (Dong-Je medical school) one hundred years ago by the Japanese invasion.

In 2008, the School of Korean Medicine was established inside Pusan National University with the 50 undergraduate students on the Yangsan medical campus. The new affiliated Korean Medical Hospital and Research Center for Clinical Studies are under construction.

Compared with common private traditional medicine undergraduate schools (6 years), this is a special graduate school (4+4).

General Hospital of Koryo Medicine

Koryo medicine is a form of traditional medicine used in North Korea and promoted by the North Korean government, providing half of the reported healthcare in the country. It is largely practised in the General Hospital of Koryo Medicine, Pyongyang. Examples of Koryo medicine sold commercially are Kumdang-2 and Royal Blood-Fresh, sold by the Pugang Pharmaceutic Company, both of which are popular with Chinese tourists to North Korea. ��

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1.2.6 Indian Medicine ^m

Indian medicine began with the belief that illness was caused by the Gods or by demons and was a punishment for bad behaviour. Over time however other beliefs arose such as that which considered good health required a balance being kept between the elements of air, bile and mucous.

India developed surgery to a higher standard, than any of the other ancient civilizations. This was because the prohibition on human dissection which existed in Europe, China and the Arab world did not exist in India. This enabled the Indian physicians to obtain a good knowledge of human bones, muscles, blood vessels and joints. A wide variety of surgical operations was carried out, including cosmetic surgery on people who had been mutilated as part of a legal punishment. An adulterous wife could have her nose cut of as a punishment and Indian surgeons learnt how to repair the damage and replace the nose.

India is a land of many diseases and Indian doctors were familiar with 1,120 different diseases. They guessed the connection between malaria and mosquitoes, noticed that the plague was foreshadowed by the death of large numbers of rats and that flies could infect food causing intestinal disease. They were also aware that cleanliness could help in the prevention of disease.

1.2.6.1 Indian Systems of Medicine: A Brief Profile ^o

Abstract

Medicinal plants based traditional systems of medicines are playing important role in providing health care to large section of population, especially in developing countries. Interest in them and utilization of herbal products produced based on them is increasing in developed countries also. To obtain optimum benefit and to understand the way these systems function, it is necessary to have minimum basic level information on their different aspects. Indian Systems of Medicine are among the well known global traditional systems of medicine. In this review, an attempt has been made to provide general information pertaining to different aspects of these systems. This is being done to enable the readers to appreciate the importance of the conceptual basis of these system in evolving the material medica. The aspects covered include information about historical background, conceptual basis, different disciplines studied in the systems, Research and Development aspects, Drug manufacturing aspects and impact of globalization on Ayurveda. In addition, basic information on Siddha and Unani systems has also been provided.

Key words: Indian System of Medicine, Ayurveda, Unani, Siddha, Indigenous systems of medicine, Traditional systems of medicine

Introduction

It is a well-known fact that Traditional Systems of medicines always played important role in meeting the global health care needs. They are continuing to do so at present and shall play major role in future also. The system of medicines which are considered to be Indian in origin or the systems of medicine, which have come to India from outside and got assimilated in to Indian culture are known as Indian Systems of Medicine (Prasad, 2002). India has the unique distinction of having six recognized systems of medicine in this category. They are- Ayurveda, Siddha, Unani and Yoga, Naturopathy and Homoeopathy. Though Homoeopathy came to India in 18th Century, it completely assimilated in to the Indian culture and got enriched like any other traditional system hence it is considered as part of Indian Systems of Medicine (Prasad, 2002). Apart from these systems- there are large number of healers in the folklore stream who have not been organized under any category. In the present review, attempt would be made to provide brief profile of three systems to familiarize the readers about them so as to facilitate acquisition of further information.

Ayurveda

Most of the traditional systems of India including Ayurveda have their roots in folk medicine. However, what distinguishes Ayurveda from other systems is that it has a well-defined conceptual framework that is consistent throughout the ages. In conceptual base, it was perhaps highly evolved and far ahead of its time. It was among the first medical systems to advocate an integrated approach towards matters of health and disease. Another important distinguishing feature of Ayurveda is that unlike other medical systems, which developed their conceptual framework based on the results obtained with the use of drugs and therapy, it first provided philosophical framework that determined the therapeutic practice with good effects. Its philosophical base is partly derived from �Samkhya� and �Nyaya vaisheshika� streams of Indian philosophy. This enabled it to evolve into rational system of medicine quite early in its evolution and to get detached from religious influence. It laid great emphasis on the value of evidence of senses and human reasoning (Ramachandra Rao, 1987).

Historical background

Ayurveda literally means the Science of life. It is presumed that the fundamental and applied principles of Ayurveda got organized and enunciated around 1500 BC. Atharvaveda, the last of the four great bodies of knowledge- known as Vedas, which forms the backbone of Indian civilization, contains 114 hymns related to formulations for the treatment of different diseases. From the knowledge gathered and nurtured over centuries two major schools and eight specializations got evolved. One was the school of physicians called as �Dhanvantri Sampradaya� (Sampradaya means tradition) and the second school of surgeons referred in literature as �Atreya Sampradaya�. These schools had their respective representative compilations- Charaka Samhita for the school of Medicine and Sushruta Samhita for the school of Surgery. The former contains several chapters dealing with different aspects of medicine and related subjects. Around six hundred drugs of plant, animal and mineral origin have been mentioned in this treatise.

Sushruta Samhita primarily deals with different aspects of fundamental principles and theory of surgery. More than 100 kinds of surgical instruments including scalpels, scissors, forceps, specula etc. are described along with their use in this document. Dissection and operative procedures are explained making use of vegetables and dead animals. It contains description of about 650 drugs and discusses different aspects related to other surgery related topics such as anatomy, embryology, toxicology and therapeutics (http://www.indianmedicine.nac.in). Vagabhata�s �Astanga-Hridaya� is considered as another major treatise of Ayurveda. The above three documents are popularly known as �Brihat trayees� (the big or major three). In addition to these three scholarly and authoritative treatises a vast body of literature exist in the form of compilations covering a period of more than 1500 years (http://www.indianmedicine.nac.in).

Till the medieval period it was perhaps the only system available in the Indian sub-continent at that time to cater to the healthcare requirement of the people. It enjoyed the unquestioned patronage and support of the people and their rulers. This can be considered as the golden period of Ayurveda because most of the work related to basic concepts, enunciation of different principles, evolvement of different formulations occurred during this period. The patronage for the Ayurvedic system of medicine considerably decreased during the medieval period, which was marked by unsettled political conditions in the country and series of invasion by foreigners. The neglect became worse during British rule during which importance was given to Allopathy through official patronage. In the early part of 20th century interest in Ayurveda rekindled as part of national freedom movement. People�s representatives even in British India and princely states started asking for suitable measures to develop Ayurveda on scientific lines (http://www.indianmedicine.nac.in).

After India gained Independence from the British rule in 1947, the movement for revival of Traditional Systems of Medicine gained momentum. The systems got official recognition and became part of the National Health care network to provide health care to the country�s citizen. Government of India initiated a series of measures to improve the position of Ayurveda as one of the major health care systems vital for catering to the primary health care needs of the country. A number of hospitals and colleges for Ayurveda were established. The other major initiatives were establishment of a research Institute to take care of the R & D needs (Central Institute of Research in Indigenous System of Medicine (CIRISM)- in 1955); a Post Graduate Training Centre of Ayurveda in 1956- to impart Post graduate education; establishment of a University- named Gujarat Ayurved University at Jamnagar in the Gujarat State in 1967; creation of Central Council of Indian Medicine (CCIM) in 1972 for regulating Education and Registration in Ayurveda, Siddha and Unani systems of medicine. A research council named Central Council for Research in Indian Medicine, Homoeopathy and Yoga (CCRIMH) was established in 1971. Subsequently, this council was bifurcated to create three separate councils -Central Council for Research in Ayurveda & Siddha (CCRAS), Central Council for Research in Unani Medicine (CCRUM), Central Council for Research in Homoeopathy (CCRH) and Central Council for Research in Naturopathy and Yoga (CCRNY) . National Institute of Ayurveda (NIA) was established at Jaipur in Rajasthan state. Recently another University has been established known as Rajasthan Ayurved University- Jodhpur (Rajasthan state). A draft national policy for the development of Indian System of Medicine has been prepared which is available on the web site of Department of Ayurveda - (http://www.indianmedicine.nac.in).

THE CONCEPT OF HEALTH IN AYURVEDA

In India, Ayurveda is considered not just as an ethnomedicine but also as a complete medical system that takes in to consideration physical, psychological, philosophical, ethical and spiritual well being of mankind. It lays great importance on living in harmony with the Universe and harmony of nature and science. This universal and holistic approach makes it a unique and distinct medical system. This system emphasizes the importance of maintenance of proper life style for keeping positive health. This concept was in practice since two millennia and the practitioners of modern medicine have now taken into consideration importance of this aspect. Not surprisingly the WHO�s concept of health propounded in the modern era is in close approximation with the concept of health defined in Ayurveda (Kurup, 2004).

THE PHILOSOPHICAL BACKGROUND

The basic foundation is the fundamental doctrine according to which whatever present in the Universe (macrocosm) should be present in the body (the microcosm). It has been conceptualized that the universe is composed of five basic elements named Prithvi (Earth), Jala (Water), Teja (Fire), Vayu (Air) and Akash (Space/Ether). The human body is derived from them in which these basic elements join together to form what are known as �Tridoshas� (humors) named as Vata, Pitta and Kapha. These humors govern and control the basic psycho-biological functions in the body. In addition to these three humors, there exist seven basic tissues (saptha dhatus)- Rasa, Rakta, Mamsa, Meda, Asthi, Majja and Shukra- and three waste products of the body (mala) such as faeces, urine and sweat. Healthy condition of the body represents the state of optimum equilibrium among the three doshas. Whenever this equilibrium is disturbed due to any reason- disease condition results. The growth and development of the body components depend on nutrition provided in the form of food. The food is conceptualized to be composed of the basic five elements mentioned above. Hence it is considered to be the basic source material to replenish or nourish the different components of the body after the action of bio-fire (Agni).

The tissues of the body are considered as the structural entities and the humours are considered as physiological entities, derived from different combinations and permutations of the five basic elements (http://www.indianmedicine.nac.in).

THE CONCEPT OF PATHOGENESIS

People are categorized in to different categories based on their psychosomatic constitution. Constitution specific daily (Dinacharya) and seasonal routines (Ritucharya) are prescribed to maintain positive health. Body may become afflicted with disease if these routines are not adhered to. This will lead to the loss of equilibrium among the three humors. The loss of equilibrium of the three humors can also occur as a consequence of dietary indiscrimination, undesirable habits, seasonal abnormalities, improper exercise or erratic application of sense organs and incompatible actions of the body and mind.

Disease condition may ensue due to other reasons also. For example, any external factor like microorganism, changes in the climatic conditions may cause the accumulation of dosha leading to disturbance in the doshic equilibrium and vitiation of doshas. It is conceptualized that normally doshas are circulated through macro and micro-channels known as srotas. The srotas are the important medium through which the body tissues get their nutrition and also the metabolic end products are transported out of the tissue. If any blockade occurs (srotorodha) due to accumulation of doshas, the bi-directional flow of nutrients and end products (malas) gets affected. The doshas accumulated in the region react with the dushyas (reactants- in this case tissues) resulting in a condition known as dosha dushya sammurchana- this affects body metabolism. Ama, which is a semi-processed intermediary product of metabolism, gets accumulated. At this stage the prodromal symptoms of the disease gets manifested. Thus disturbances in the bio-channels are considered to be the main reason for the expression of diseased state of an organ or system.

DIAGNOSIS

The diagnosis is always done by considering the patient as a whole object to be examined. The physician takes a careful note of the patient�s internal physiological characteristics and mental disposition. He also studies other factors like- the affected bodily tissues, humors, the site at which the disease is located, patient�s resistance and vitality, his daily routine, dietary habits, the gravity of clinical conditions, condition of digestion and details of personal, social, economic and environmental situation of the patient. The general examination is known as ten-fold examination- through which a physician examines the following parameters in the patient- 1. Psychosomatic constitution, 2. Disease susceptibility, 3. Quality of tissues, 4. Body build, 5. Anthropometry, 6. Adaptability, 7. Mental health, 8. Digestive power, 9. Exercise endurance and 10. Age. In addition to this, examination of pulse, urine, stool, tongue, voice and speech, skin, eyes and overall appearance is also carried out (Kurup, 2002).

TREATMENT ASPECTS

The treatment lies in restoring the balance of disturbed humors (doshas) through regulating diet, correcting life-routine and behavior, administration of drugs and resorting to preventive non-drug therapies known as �Panchkarma� (Five process) and �Rasayana� (rejuvenation) therapy. Before initiating treatment many factors like the status of tissue and end products, environment, vitality, time, digestion and metabolic power, body constitution, age, psyche, body compatibility, type of food consumed are taken in to consideration.

TYPES OF TREATMENT

The treatments are of different types- a- Shodhana therapy (purification treatment), b-Shamana therapy (palliative treatment), Pathya Vyavastha (prescription of appropriate diet and activity), Nidan Parivarjan (avoidance of causes and situations leading to disease or disease aggravation), Satvajaya (psychotherapy) and Rasayan (adaptogens- including immunomodulators, anti-stress and rejuvenation drugs) therapy. Dipan (digestion) and Pachan (assimilation) enhancing drugs are considered good for pacifying the vitiated doshas (humors).

This therapy is supposed to dissolve the vitiated and accumulated doshas by improving the agni (digestive power) and restoring the deranged metabolic process. In severe conditions the above therapy has to be supplemented with purificatory processes like Panchakarma. In this therapy initially the accumulated vitiated dosha is liquefied by resorting to external and internal oleation of the patient; followed by sudation (swedhana) and elimination of vitiated dosha through emesis (Vamana) or purgation (Virechana), Basti (enema- evacuating type) and Nasya (nasal insufflation).

Shodhana therapy provides purificatory effect through which therapeutic benefits can be derived. This type of treatment is considered useful in neurological and musculo-skeletal disorders, certain vascular or neuro-vascular states, respiratory diseases, and metabolic and degenerative disorders. Shamana therapy involves restoring normalcy in the vitiated doshas (humors). This is achieved without causing imbalance in other doshas. In this use of appetizers, digestives, exercise and exposure to sun and fresh air are employed. In the Pathya Vyavastha type of treatment certain indications and contraindications are suggested with respect to diet, activity, habits and emotional status. In Nidan Parivarjan type of treatment the emphasis is on avoiding known causes of the disease by the patient. In Satvavajaya type of treatment the emphasis is on restraining the mind from the desires for unwholesome objects and Rasayana therapy deals with the promotion of strength and vitality (http://www.indianmedicine.nac.in).

DIETICS IN AYURVEDA

Ayurveda lays great emphasis on the diet regulation. According to Ayurvedic concepts food has great influence over physical, temperamental and mental development of an individual. The food is the basic material for the production of the body and life supporting vital matter known as Rasa. The rasa is converted to body components and supports all types of life activities.

DIFFERENT DISCIPLINES OF AYURVEDA

Ayurveda is known as Astanga Ayurveda- means that which is made up of eight parts. The eight major divisions of Ayurveda are as follow as:

1. Kayachikitsa (Internal Medicine) 2. Kaumar Bhritya (Pediatrics) 3. Bhootavidya (Psychiatry) 4. Shalakya (Otorhinolaryngology and Ophthalmology) 5. Shalya (Surgery) 6. Agada Tantra (toxicology) 7. Rasayana (Geriatrics) and 8. Vajikarana (Aprhodisiacs and Eugenics)

Present status of Ayurveda and other Indigenous Systems of Medicine in India

Regulation of the practice of ISM & H

Eighteen major states have independent Directorate to look after ISM related issues. In six states the ISM is administrated under the Health Directorate of the State, in around six smaller states and Union Territories Officer in�charges look after the issues concerned with ISM. At present there are more than 6.11 lakh practioners of ISM & H. The number of Hospitals and dispensaries in this sector is more than 26,000 where free treatment facility is available. In addition large number of practioners in the un-organized folklore sector provide remedies to considerable portion of the population (http://www.indianmedicine.nac.in )

EDUCATION

At present there are more than 200 colleges, which offer a four and half year course leading to Bachelor Degree in Ayurvedic Medicine and Surgery, followed by one year internship. Similarly 2 colleges offer graduate degree in Siddha System of Medicine and 34 colleges offer degree in Unani System of Medicine and 130 colleges offer courses leading to degree in Homoeopathy. The turnover of candidates from these colleges exceeds 9,000 per year. More than 30 Institutes offer postgraduate courses for Ayurveda and specialization is available in 16 disciplines. In addition there is National Academy of Ayurveda, which imparts PG education under the scheme of �Guru Shishya parampara�. This scheme has been created with a view to provide education on traditional lines like what used to be in ancient times. In ancient times students used to visit the abode of the teacher to serve him while learning the art of healing from him. At present around 750 Post graduate scholars are turned out every year (the duration of course is 3 years). The degree offered is M.D. (Ayu) and M.S. (Ayu). Recently Pharmacy colleges have been opened which offer D.Pharm (Ayu), B.Pharm (Ayu) and M.Pharm (Ayu) (for further details visit-http://www.ayurveduniversity.com). Training programmes mainly, in-house are conducted, through out the country to train para-ayruvedic staff. These trained technicians help in carrying out therapeutic process like panchakarma and ksarasutra (an effective surgical procedure for removing hemorrhoids). Similarly pharmacists are trained to shoulder responsibilities of running an ayurvedic pharmacy.

RESEARCH AND DEVELOPMENT

The research activities are being carried out by Central Council for Research in Ayurveda & Siddha (CCRAS) and similar councils for Unani, Homoeopathy and Naturopathy & Yoga. The CCRAS is the premier agency involved in research and development (http://www.ccras.com). It has 89 field units, which have been re-organized in to 30 institutes and units. The types of activities undertaken are clinical research- involving planned clinical trial of single and compound ayurvedic preparations and drug research which includes medico-botanical surveys, cultivation of medicinal plants, pharmacognostical studies, phytochemical studies, drug standardization, pharmacological and toxicological studies. A vast body of data is available in various published literature and data bases (Sharma et al 2000, 2001, 2002; Billore et al 2004; Satyavati et al, 1976, 1987, Satyavati, 2005; Mishra, 2004; De et al 1993; Chatterjee and Pakrashi (1995-1997); Gupta and Tandon (2004) ; Wealth of India series ( 1959-69; 1985 and 2000) ; Dahanukar et al 2000; Rastogi and Dhawan (1982); Ayurvedic Pharmacopoeia Part- I in three volumes (Anonymous-1989, 1999 and 2000) ; Sivarajan and Balachandran (1999); Raghunathan and Mitra (1982) and five volumes (1-5) by Rastogi and Mehrotra (1990, 1991, 1993 ,1995 and 1998). Literary research, which involves publication of rare and classical manuscripts of ISM & H., is also carried out (http://www.ccras.com).

Besides research councils research activities are carried out in Post Graduate centers and Institutes of national importance like- Central Drug Research Institute (CDRI), Central Institute of Medicinal and Aromatic Plants (CIMAP), National Botanical Research Institutes (NBRI) etc and R & D centers attached to Ayurvedic drug manufacturing firms (Kurup- 2004). However the main tendency is to consider medicinal plants used in Ayurveda as source material for bio-prospecting of drugs. There are very few studies, which take in to consideration the ayurvedic concept behind a given formulation. Ayurveda has a very well developed drug formulation discipline known as �Bhaishajya Kalpana�, which provides great deal of information about methods of drug preparation, use of adjuvants, collection and processing drugs in a particular manner. Research efforts on this aspect and on basic principles of Ayurveda are yet to be undertaken in concerted manner.

DRUG MANUFACTURING IN AYURVEDIC SECTOR

Ayurvedic drugs are marketed in various forms. They are available in both classical forms (tablets, powder, decoction, medicated oil, medicated ghee, fermented products) and modern drug presentation forms like capsules, lotions, syrups, ointments, liniments, creams, granules etc. There are more than 8500 manufacturers of Ayurvedic drugs in the country and the gross turnover of drugs used in all the ISM & H systems is approximately around 1 billion US dollars. Drug manufacturing in this sector is regulated by Drugs and Cosmetic act (1940) and rules (1945) (Jain, 2001). Subsequently many chapters have been added to these acts over the years. Three types of agencies are involved in the administration of the Acts and Rules enacted by the parliament. There is Drug Technical Advisory Board and Drug Consultative Committee to advise the Govt., The Drug Controller General of India who with the help of the supporting staff is in charge of licensing and enforcing different laws related to drug manufacturing and dispensing. At the state level Food and Drug Administration Commissioners shoulder this responsibility. Recently Good Manufacturing Process for ISM has been defined which have to be followed by all the agencies involved in the manufacturing of drugs in this sector (http://www.indianmedicine.nac.in ).

GLOBALIZATION OF AYURVEDA

Globalization of Ayurvedic practice has gained momentum in the past two decades. Ayurvedic drugs are used as food supplements in USA, European Union and Japan. Many physicians practice Ayurveda in many parts of the world. Facilities are available in countries like USA, Argentina, Australia, Brazil, New Zealand, South Africa, Czech Republic, Greece, Italy, Hungary, Netherlands, Russia, UK, Israel, Japan, Nepal, Sri Lanka (Kurup, 2004) for imparting short and long-term training in Ayurveda.

The concepts of proper life styles, dietary habits, daily and seasonal routines followed in Ayurveda can be adopted with suitable modification to different countries in different parts of the globe after giving due consideration to the cultural milieu existing in those countries and also to the constitutional profile of their population. Attempts can also be made to utilize the medicinal plant resources of these countries for meeting the health care needs of their people after categorization of the plants according to Ayurvedic concepts. Drugs used in ISM can be used as adjuvant to the main drugs used in Allopathy. Non-drug therapeutic approaches such as �Panchakarma�, �Ksarasutra� etc can certainly be integrated into other health systems broadening the choices available to physicians and patients.

A recent review (Dahanukar et al., 2000) points out that more than 13,000 plants have been investigated during the past 5 years. Number of medicinal plants have been shown to possess important pharmacological activities in pre-clinical testing however the generated leads have not been adequately followed up with double blind, placebo controlled clinical trails. Curcuma longa Linn, Boswellia serrata Roxb. ex Coleb., Picrorhiza kurroa Royle ex Benth, Terminalia chebula Retz., Emblica officinalis Gaertn., Bacopa monnieri (Linn.) Pennel, Boerhavia diffusa Linn, Phyllanthus niruri Linn, Celastrus paniculatus, Ocimum sanctum Linn, Gymnema sylvestre R.Br., Momordica charantia Linn, Commiphora wighti (Arn.) Bhandari, Withania somnifera (Linn.) Dunal, Pterocarpus marsupium Roxb., Tinospora cordifolia (Willd). Miers. Ex Hook.f. & Thomson, Trichopus zeylanicum, Terminalia arjuna (Roxb.) Wight & Arn etc have great potential to develop in to drugs of global importance. Table-1 provides list of some of the important medicinal plants with good potential to develop at global level. This list is not exhaustive and is based mainly on the author�s own preference. Many of the drugs in the list are not available in sufficient quantity in India but may be available in other countries especially Nigeria where Commiphora species are abundant- they can be the source of supply to Indian ISM based industry. One of the main lacunae is the lack of co-ordinated multi-disciplinary studies to prove their clinical efficacy beyond doubt. This aspect should be the main focus of future research endeavors.

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1.2.6.2 Siddha system of medicine ^w

Siddha system of medicine is practiced in some parts of South India especially in the state of Tamilnadu. It has close affinity to Ayurveda yet it maintains a distinctive identity of its own. This system has come to be closely identified with Tamil civilization. The term 'Siddha' has come from 'Siddhi'- which means achievement. Siddhars were the men who achieved supreme knowledge in the filed of medicine, yoga or tapa (meditation) (Narayanaswamy, 1975).

It is a well-known fact that before the advent of the Aryans in India a well-developed civilization flourished in South India especially on the banks of rivers Cauvery, Vaigai, Tamiraparani etc. The system of medicine in vogue in this civilization seems to be the precursor of the present day Siddha system of medicine. During the passage of time it interacted with the other streams of medicines complementing and enriching them and in turn getting enriched. The materia medica of Siddha system of medicine depends to large extent on drugs of metal and mineral origin in contrast to Ayurveda of earlier period, which was mainly dependent upon drugs of vegetable origin.

According to the tradition eighteen Siddhars were supposed to have contributed to the development of Siddha medicine, yoga and philosophy. However, literature generated by them is not available in entirety. In accordance with the well-known self-effacing nature of ancient Indian Acharyas (preceptors) authorship of many literary work of great merit remains to be determined. There was also a tradition of ascribing the authorship of one�s work to his teacher, patron even to a great scholar of the time. This has made it extremely difficult to clearly identify the real author of many classics.

PHILOSOPHICAL FOUNDATION

According to the Siddha concepts matter and energy are the two dominant entities, which have great influence in shaping the nature of the Universe. They are called Siva and Sakthi in Siddha system. Matter cannot exist without energy and vice-versa. Thus both are inseparable. The universe is made up of five proto-elements. The concept of five proto-elements and three doshas in this system of medicine is quite similar to Ayurvedic concept pertaining to them. However, there are certain differences in the interpretation (Narayanaswamy, 1975). The concepts behind diagnostic measures also show great similarities differing in certain aspects only. Diagnosis in Siddha system is carried out by the well �known �ashtasthana pareeksha� (examination of eight sites) that encompasses examination of nadi (pulse), kan (eyes), swara (voice), sparisam (touch), varna (colour), na (tongue), mala (faeces) and neer (urine). These examination procedures are provided in greater detail in classical Siddha literature in comparison to classical literature of Ayurveda (Narayanaswamy, 1975).

PRINCIPLES OF TREATMENT

Similar to Ayurveda, Siddha system also follows ashtanga concept with regards to treatment procedures. However the main emphasis is on the three branches - Bala vahatam (pediatrics), Nanjunool (toxicology) and Nayana vidhi (ophthalmology). The other branches have not developed to the extent seen in Ayurveda. The surgical procedures, which have been explained in great detail in Ayurvedic classics, do not find mention in Siddha classics. The therapeutics in both the systems can be broadly categorized into samana and sodhana therapies. The latter consists of well-known procedures categorized under panchakarma therapy. This therapy is not that well developed in Siddha system, only the vamana therapy has received attention of the Siddha physicians (Narayanaswamy, 1975).

MATERIA MEDICA

The concept pertaining to drug composition, the concept of rasapanchaka (concept explaining drug properties) is almost similar in both the systems of medicine. One of the major characteristic features of Siddha materia medica is utilization of mineral and metal-based preparations to greater extent in comparison to the drugs of vegetable origin.

The mineral and metal-based drugs in Siddha System are categorized under the following categories:

1. Uppu (Lavanam)- drugs that are dissolved in water and get decrepitated when put into the fire giving rise to vapor.

2. Pashanam: drugs that are water insoluble but give off vapors when put in to fire

3. Uparasam: Similar to pashanam chemically but have different actions.

4. Ratnas and uparatnas, which include drugs based on precious and semi-precious stones

5. Loham - metals and metal alloys that do not dissolve in water but melt when put in to fire and solidify on cooling.

6. Rasam: drugs that are soft, sublime when put in to fire changing into small crystals or amorphous powders.

7. Gandhakam: sulphur is insoluble in water and burns off when put into fire. From the above basic drugs compound preparations are derived. From the animal kingdom thirty-five products have been included in the materia medica. It is much similar to preparations used in Ayurveda. Numbers of plant-based preparations are also used in Siddha system of medicine they are quite similar in profile to those mentioned in Ayurveda.

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1.2.6.3 Unani system of medicine ^w

Historical background

Unani medicine has its origin in Greece. It is believed to have been established by the great physician and philosopher- Hippocrates (460-377 BC). Galen (130-201 AD) contributed for its further development. Aristotle (384-322 BC) laid down foundation of Anatomy & physiology. Dioscorides � the renowned physician of the 1st Century AD has made significant contribution to the development of pharmacology, especially of drugs of plant origin. The next phase of development took place in Egypt and Persia (the present day Iran). The Egyptians had well evolved pharmacy; they were adept in the preparation of different dosage forms like oils, powder, ointment and alcohol etc. (http://www.indianmedicine.nac.in).

The Arabian scholars and physicians under the patronage of Islamic rulers of many Arabian countries have played great role in the development of this system. Many disciplines like chemistry, pharmaceutical procedures like distillation, sublimation, calcinations and fermentation were developed and refined by them. There are many well-known names- only some names have been mentioned in this article. Jabir bin Hayyan (717-813 AD) a Royal physician of his time has worked on the chemical aspects; Ibne Raban Tabari (810-895 AD) is the author of the book- Firdous ul Hikmat and introduced concept of official formulary. Abu Bakar Zarakariya Razi (865-925 AD) has authored a book known as "Alhawi fit tibb". He has worked in the field of immunology. Of course the name of Bu Ali Sina (Avicenna 980-1037 AD) is always referred in all matters related to Unani. He was a renowned global level scholar and philosopher. He had great role in the development of Unani medicine in the present form. His book Alqanoon or (The canon of medicine) was an internationally acclaimed book on medicine, which was taught in European countries till the 17th century. Many physician of Arab descent in Spain have also contributed to the development of the system. Some of the important names are-Abul Qasim Zohravi (Abulcasus 946 � 1036 AD) he is the author of the famous book on surgery "Al Tasreef"-(http://www.indianmedicine.nac.in).

The Arabs were instrumental in introducing Unani medicine in India around 1350 AD. The first known Hakim (Physician) was Zia Mohd Masood Rasheed Zangi. Some of the renowned physicians who were instrumental in development of the system are- Akbar Mohd Akbar Arzani (around 1721 AD)- the author of the books- Qarabadin Qadri and Tibbe Akbar; Hakim M. Shareef Khan (1725-1807)- a renowned physician well-known for his book Ilaj ul Amraz. Hakim Ajmal Khan (1864-1927) a great name among the 20th Century Unani physicians in India. He was a multifaceted personality besides being a physician he was a scientist, politician and a freedom fighter. He was instrumental in the establishment of Unani and Ayurvedic College at Karol Bagh, Delhi. He was a keen researcher and has supervised many studies on Rauwolfia serpentina- the source plant for many well-known alkaloids like reserpine, Ajamaloon etc. Another great contributor is Hakim kabeeruddin (1894-1976), he has translated 88 Unani books of Arabic and Persian languages into Urdu. The first institution of Unani medicine was established in 1872 as Oriental College at Lahore in the undivided India. Thereafter many institutions came into existence.

After Independence Unani received boost in the form of Government support through various agencies involved in the development of ISM. At present there are more than 30 colleges offering degree course in Unani medicine and the approximate number of physician turn out is around 20,000. There are around 177 hospitals. A National Institute of Unani Medicine has been established at Bangalore in Karnataka state in 1983 in collaboration with the Govt. of Karnataka- for catering to both academic and R & D requirements. Central Council for Research in Unani Medicine (CCRUM), is the premier agency involved in R & D activities (http://www.indianmedicine.nac.in).

Table 1: Some well-known Indian medicinal plants and their uses

Botanical name	Parts used	Therapeutic uses
Acorus calamus Linn ( Araceae)	Rhizome	Nervine tonic, anti-spasmodic (Satyavati et al ., 1976; Bose et al., 1960)
Aegle marmelos (L.) Corr. (Rutaceae)	Fruit	Hypoglycemic; chemopreventive (Vyas et al., 1979; Dixit et al., 2006)
Allium sativum Linn (Alliaceae)	Bulbs	Anti-inflammatory; anti-hyperlipidemic, fibrinolytic (Dixit et al., 2006)
Aloe barbadensis Mill., and Aloe vera Tourn. Ex Linn. (Alliaceae)	Gel	Skin diseases- mild sunburn, frostbite, scalds; wound healing (Baliga, 2006)
Andrographis paniculata (Burm.f.) Wallich ex Nees (Acantahceae)	Whole plant	Cold; flu � hepatoprotection (Koul and Kapil-1994; Sharma et al., 2002a)
Asparagus racemosus Willd (Alliaceae)	Roots	Adaptogen, galactogogue (Dahanukar et al., 1997;Gupta and Mishra, 2006)
Bacopa monnieri (L) Pennel (Scorphulariaceae)	Whole plant	Anti-oxidant; memory enhancing (Singh and Dhawan, 1997)
Berberis aristata DC (Berberidaceae)	Bark, fruit, root, stem, wood	Anti-protozoal, hypoglycemic, anti-trachoma (Dutta and Iyer, 1968; Sharma et al., 2000a)
Boerhavia diffusa L. (Nyctaginaceae)	Roots	Diuretic; anti-inflammatory and anti-arthritic (Sharma et al., 2000b; Harvey, 1966)
Boswellia serrata Roxb. (Burseraceae)	Oleo resin	Anti-rheumatic; anti-colitis and anti-inflammatory, anti-cancer. (Sharma et al., 2000c)
Butea monosperma (Lam.) Taub (Fabaceae)	Bark, leaves, flowers, seeds and gum	Adaptogen; abortifacient, anti-oestrogenic, anti-gout, anti-ovulatory (Sharma et al., 2000d)
Calotropis gigantea (Linn) R. Br. (Asclepiadaceae)	Flowers, whole plant, root, leaf	Anti-inflammatory, spasmolytic, asthma (Sharma et al., 2000e)
Callicarpa macrophylla Vahl. (Verbenaceae)	Leaves, roots	Uterine disorders (Sood, 1995)
Cassia fistula Linn (Leguminosae)	Resin	Laxative, anti-pyretic, worm infestation (Joshi, 1998)
Celastrus paniculatus Willd (Celastraceae)	Whole plant	Brain tonic; memory enhancer; in the treatment of depression (Tanuja Doshi, 1991; Joglekar and Balwani, 1967)
Centella asiatica (Linn) Urban (Umbelliferae)	Whole plant	Tranquilizer; memory enhancer; wound healing- (Sharma et al., 2000 f; Suguna et al ., 1996)
Chlorophytum boriavillianum Santapau & RR Fernandus (Alliaceae)	Roots	Aphrodisiac (Farooqi et al., 2001)
Cissus quadrangularis L (Vitaceae)	Whole plant, root, stem and leaf	Bone fracture; inflammation (Deka et al., 1994) (Udupa & Prasad, 1964b)
Clerodendrum serratum (Linn) Moon (Verbenaceae)	Root, leaf, Stem	Malaria; anti-asthmatic, anti-allergic (Gupta and Gupta, 1967) (Sivarajan and Balachandran 1999a)
Commiphora mukul ( Hooker Stedor) Engl. (Burseraceae)	Resin	Hypolipidemic; obesity, rheumatoid arthritis (Satyavati, 1991)

Basic principles

According to the basic principles of Unani the body is made up of four basic elements i.e. Earth, Air, Water, Fire which have different Temperaments i.e. Cold, Hot, Wet, Dry. They give raise, through mixing and interaction, to new entities. The body is made up of simple and complex organs. They obtain their nourishment from four humors namely- blood, phlegm, black bile and yellow bile. These humors also have their specific temperament. In the healthy state of the body there is equilibrium among the humors and the body functions in normal manner as per its own temperament and environment. Disease occurs whenever the balance of humors is disturbed.

In this system also prime importance is given for the preservation of health. It is conceptualized that six essentials are required for maintenance of healthy state. They are i. Air, ii. Food and drink, iii. Bodily movements and response, iv. Psychic movement and repose, V. Sleep and wakefulness and vi. Evacuation and retention. Specific requirement for each of these six essentials have been discussed- (Syed Khaleefathullah, 2002).

The human body is considered to be made up of seven components, which have direct bearing on the health status of a person. They are 1. Elements (Arkan) 2. Temperament (Mijaz). 3. Humors (Aklat) 4. Organs (Aaza) 5. Faculties (Quwa) 6. Spirits (Arwah). These components are taken in to consideration by the physician for diagnosis and also for deciding the line of treatment (Syed Khaleefathullah, 2002).

Diagnosis

Examination of the pulse occupies a very important place in the disease diagnosis in Unani. In addition examination of the urine and stool is also undertaken. The pulse is examined to record different features like- size, strength, speed, consistency, fullness, rate, temperature, constancy, regularity and rhythm. Different attributes of urine are examined like odor, quantity, mature urine and urine at different age groups. Stool is examined for color, consistency, froth and time required for passage etc.

Treatment

Disease conditions are treated by employing four types of therapies- a- Regimental therapy, b- Dietotherapy, c-Pharmacotherapy and d- Surgery. Regimental therapy mainly consists of drug less therapy like exercise, massage, turkish bath, douches etc. Dietotherapy is based on recommendation of patient specific dietary regimen. Pharmacotherapy involves administration of drugs to correct the cause of the disease. The drugs employed are mainly derived from plants some are obtained from animals and some are of mineral origin. Both single and compound preparations are used for the treatment.

A large number of studies have been carried out on number of medicinal plants used in ISM of medicine. Central Drug Research Institute undertook a series of studies (Anonymous - 1991) under drug screening programme. Number of compilation have been published providing information about pharmacological activity profile of medicinal plants, publications are also available on the chemical profile of number of medicinal plants, Ayurvedic pharmacopoeia has been published � three volumes have come out so far, CCRAS has published a series of books under its Data base preparation project. There is an international publication on scientific validation of Ayurvedic therapies. Besides these books large number of review articles have been published in national and international Journals providing names of drugs used in particular type of disease conditions or screened for particular type of pharmacological activities.

If the situation prevailing in this sector is analyzed taking into consideration different aspects- it becomes clear that there is a perceptible trend towards increased usage of drugs used in Indian Traditional Systems especially those which are based on herbal products not only in India but in different parts of the world. However, one of the basic problems that still remained to be solved is related to proving efficacy of the products used in these systems on the basis of controlled clinical trial and complementary pharmacological studies. It is difficult to ensure consistency in the results and components in the products. This is traced mainly to lack of standardization of the inputs used and the process adopted for preparation of the formulations. Government of India has taken these aspects in to consideration and has initiated many projects for standardization of single and compound formulations along with standardization of operating procedures for important formulations. Though standardization is very difficult it is not an un-attainable goal. Once this is done it would help in promoting wider use of these drugs especially in chronic degenerative disorders. Further non-drug therapies and preventive and life management techniques are also receiving increased attention. Thus this sector seems to be poised for remarkable growth in the coming years (Kurup, 2004).

The above presentation can be considered only as brief introduction to the above systems. Lot of literature and information is available in the published literature citation of which would make this write up voluminous hence not attempted. However, the websites referred above provide sufficient information for a beginner. Full complement of information can be obtained by contacting appropriate bodies. No attempt has been made to provide information about Yoga and Naturopathy systems because they are mainly non-drug therapies. Similarly, Homoeopathy system has not been discussed since it is well known out side Indian sub-continent.

History of Ayurveda� a heritage of healing

The Origins �

The word �veda� means knowledge. The evolution of the Indian art of healing and living a healthy life comes from the four Vedas namely: Rig veda, Sama veda, Yajur veda and Atharva veda. Ayurveda attained a state of reverence and is classified as one of the Upa-Vedas - a subsection - attached to the Atharva Veda. The Atharva Veda contains not only the magic spells and the occult sciences but also the Ayurveda that deals with the diseases, injuries, fertility, sanity and health.

Ayurveda incorporates all forms of lifestyle in therapy. Thus yoga, aroma, meditation, gems, amulets, herbs, diet, astrology, color and surgery etc. are used in a comprehensive manner in treating patients. Treating important and sensitive spots on the body called Marmas is described in Ayurveda. Massages, exercises and yoga are recommended.

History

The knowledge we have now is by three surviving texts of Charaka, Sushruta and Vaghbata.

Charaka (1st century A.D.) wrote Charaka Samhita (samhita- meaning collection of verses written in Sanskrit). Sushruta (4th century A.D.) wrote his Samhita i.e Sushruta Samhita.

Vaghbata (5th century A.D.) compiled the third set of major texts called Ashtanga Hridaya and Ashtanga Sangraha. Charaka�s School of Physicians and Sushruta�s School of Surgeons became the basis of Ayurveda and helped organize and systematically classify into branches of medicine and surgery.

Sixteen major supplements (Nighantus) were written in the ensuing years � Dhanvantari Bahavaprakasha, Raja and Shaligrama to name a few � that helped refine the practice of Ayurveda. New drugs were added and ineffective ones were discarded. Expansion of application, identification of new illnesses and finding substitute treatments seemed to have been an evolving process. Close to 2000 plants that were used in healing diseases and abating symptoms were identified in these supplements.

Dridhabala in the 4th century revised the Charaka Samhita. The texts of Sushruta Samhita were revised and supplemented by Nagarjuna in the 6th century.

There developed eight branches/divisions of Ayurveda:

1. Kaya-chikitsa (Internal Medicine)

2. Shalakya Tantra (surgery and treatment of head and neck, Ophthalmology and ear, nose, throat)

3. Shalya Tantra (Surgery)

4. Agada Tantra (Toxicology)

5. Bhuta Vidya (Psychiatry)

6. Kaumara bhritya (Pediatrics)

7. Rasayana (science of rejuvenation or anti-ageing)

8. Vajikarana (the science of fertility and aphrodisiac)

Many modern medications were derived from plants alluded to in Ayurveda texts. The oft-cited example is that of Rauwolfia serpentina that was used to treat headache, anxiety and snakebite. Its derivative is used in treating blood pressure today.

Two areas of contribution of Indian physicians were in treating snakebite and prevention of small pox. Detailed account of steps to be followed after a poisonous snake bite including application of tourniquet and lancing the site by connecting the two fang marks and sucking the poison out is described. A decoction of the medicinal plant Rauwolfia serpentina is next applied to the wound.

A form of vaccination for small pox was commonly practiced in India long before the West discovered the method. A small dose of pus from the pustule of small pox lesion was inoculated to develop resistance.

Charaka Samhita Charaka was said to have been in the court of the Kushana king, Kanishka during the 1st century A. D. Some authors date him as far back as the 6th century B.C. during Buddha period. The sacred trust between physician and patient was held in high esteem by Charaka and patient confidentiality, similar to the Hippocratic Oath, was deemed the proper conduct for a practicing physician. Charaka also told us that the word Ayurveda was derived from Ayus, meaning life and Veda meaning knowledge. Nevertheless, according to Charaka the word Ayus denotes more than just life. Ayus denotes a combination of the body, sense organs, mind and soul. The principles of treatment in Charaka�s teachings took a holistic approach that treated not just the symptoms of the disease but the body, mind and soul as single entity.

Compiled by Charaka in the form of discussions and symposiums held by many scholars, Charaka Samhita is the most ancient and authoritative text that has survived. Written in Sanskrit in verse form, it has 8400 metrical verses. The Samhita deals mainly with the diagnosis and treatment of disease process through internal and external application of medicine. Called Kaya-chikitsa (internal medicine), it aims at treating both the body and the spirit and to strike a balance between the two. Following diagnosis, a series of methods to purify both the body and spirit with purgation and detoxification, bloodletting and emesis as well as enema (known as Pancha-karma) are utilized. The emphasis seems to be to tackle diseases in the early phase or in a preventative manner before the first symptoms appear.

Ayurvedic diagnosis and treatment is traditionally divided into eight branches (sthanas) based on the approach of a physician towards a disease process. Charaka described them thus:

1. Sutra-sthana - generalprinciples

2. Nidana-sthana - pathology

3. Vimana-sthan- diagnostics

4. Sharira-sthana - physiology and anatomy

5. Indriya-sthana - prognosis

6. Chikitsa-sthana - therapeutics

7. Kalpa-sthana - pharmaceutics

8. Siddhi-sthana - successful treatment.

Detailed accounts of various methods of diagnosis, study of various stages of symptoms and the comprehensive management and treatment of debilitating diseases like diabetes mellitus, tuberculosis, asthma and arthritic conditions are to be found in the Charaka Samhita. There is even a detailed account of fetal development in the mother�s womb, which can rival descriptions of modern medical textbooks.

Charaka also wrote details about building a hospital. A good hospital should be located in a breezy spot free of smoke and objectionable smells and noises. Even the equipment needed including the brooms and brushes are detailed. The personnel should be clean and well behaved. Details about the rooms, cooking area and the privies are given. Conversation, recitations and entertainment of the patient were encouraged and said to aid in healing the ailing patient.

SushrutaSamhita Sushruta was a surgeon in the Gupta courts in the 4th century A.D. Though Indian classics is full of accounts of healing through transplantation of head and limbs as well as eye balls, Sushruta Samhita is the first authentic text to describe methodology of plastic surgery, cosmetic and prosthetic surgery, Cesarean section and setting of compound fractures.

Sushruta had in his possession an armamentarium of 125 surgical instruments made of stone, metal and wood. Forceps, scalpels, trocars, catheters, syringes, saws, needles and scissors were all available to the surgeon. Rhinoplasty (plastic surgery of the nose) was first presented to the world medical community by Sushruta in his Samhita, where a detailed method of transposition of a forehead flap to reconstruct a severed nose is given. Severed noses were common form of punishment. Torn ear lobes also were common due to heavy jewelry worn on ear lobes. Sushruta described a method of repair of the torn ear lobes. Fitting of prosthetics for severed limbs were also commonly performed feats. Sushruta wrote, �Only the union of medicine and surgery constitutes the complete doctor. The doctor who lacks knowledge of one of these branches is like a bird with only one wing.� While Charaka concentrated on the kaya-chikitsa (internal medicine). Sushruta�s work mainly expounded on the Shalya Tantra (surgery).

The Samhita contains mostly poetry verses but also has some details in prose. 72 different ophthalmic diseases and their treatment are mentioned in great detail. Pterygium, glaucoma and treatment of conjunctivitis were well known to Sushruta. Removal of cataract by a method called couching, wherein the opaque lens is pushed to a side to improve vision was practiced routinely. Techniques of suturing and many varieties of bandaging, puncturing and probing, drainage and extraction are detailed in the manuscript.

Ashtanga Hridaya Vaghbata in the 5th century compiled two sets of texts called Ashtanga Sangraha and Ashtanga Hridaya. It details the Kaya-chikitsa of Charaka Samhita and the various surgical procedures of Sushruta Samhita. The emphasis seems to be more on the physiological rather than the spiritual aspects of the disease processes. Ashtanga Sangraha is written in prose whereas the Ashtanga Hridaya is in poetry for recitation of the Verses.

The Ancient ayurvedic Physician Originally only Brahmins (a certain caste) were practicing physicians. Later people from other castes became well versed in the art of healing and a term Vaidya came to be applied to the practitioners. Merely by their art and knowledge, the physicians gained high social status regardless of their caste of birth. The court physician was of political importance and sat on the right side of the throne, an important symbolic place. Though the physician, patient, the nurse and the medicine were all important in curing a disease, the physician was thought to be the most important.

The codes of conduct for physicians and medical students were laid down by the texts. The poor and downtrodden were to be treated free of charge. Others were charged according to their ability to pay.

The physician was expected to behave in an exemplary manner, conforming to the highest ideals of professional and personal life. His dress, manner and speech were expected to be beyond reproach. Medical education was arduous, consisting of many years of sacrifice learning the art of healing. Visiting the sick, collecting herbs and preparation of drugs, memorizing the Vedic texts of Ayurveda, performing procedures on dead animals, melons, and leather bottles and bladders were part of the training. These exercises helped refine both theoretical and practical training of the student. When finally, the student is deemed ready to practice on his own, he was certified by the ruler.

Recent History before Ayurveda began its recent renewal in the West, it went through a period of decline in India when Western medical education became dominant during the era of British rule.

Ayurveda became a second-class option used primarily by traditional spiritual practitioners and the poor. After India gained its independence in 1947, Ayurveda gained ground and new schools began to be established. Today more than five hundred Ayurvedic companies and hospitals have opened in the last ten years, and several hundred schools have been established. Although Ayurveda remains a secondary system of health care in India, the trend toward complementary care is emerging, and Western and Ayurvedic physicians often work side by side.

Interest in Ayurveda in the West began in the mid 1970's as Ayurvedic teachers from India began visiting the United States and Europe. By sharing their knowledge, they have inspired a vast movement toward body-mind-spirit medicine. Today Ayurvedic colleges are opening throughout Europe, Australia, and the United States.

OUR COSMIC BEGINNING

TRIGUNA

Three primordial forces, or principles (GUNAS) namely Sattva, Rajas & Tamas, interweaving to create the five elements - space, air, fire, water and earth � birth the entire creation.

The principle of stillness, tamas, replenishes the universe and its beings and is the main principle of support within the physical universe. The principle of self-organizing activity, rajas, gives motility and co-ordination to the universe and human life. The Principal of harmonic and cosmic intelligence, sattva, maintains universal and individual stasis and awareness. These three cosmic principles, called gunas, operating through the five elements they have created, directly interface with human existence.

On the physical plane, tamas works closely with the physical functions of the body, summarized as bodily humors called doshas, tissues and wastes. Tamas is said to exercise the greatest influence on the body�s water aspect, or Kapha dosha(humour)* human and gives the body its ability to cogitate and to endure long periods of gestation. Rajas influences the psychic plane of existence and works closely with the psychological functions of the body. On the physical level, rajas is said to exercise the most influence on the body�s air aspect, Vata Dosha (humour)*. It gives us our power to transform what is being perceived externally into thoughts, concepts, visions, and dreams.

Referred to as the universe�s cosmic intelligence, the third principle sattva, permeates each and every minute cell of our being. It functions through our existential states of awareness, although it also influences the physical organism to some extent. Within the physical body, sattva is said to exercise the most influence on its fire aspect, Pitta dosha (humour)*. Closely linked to the universal subtle fire, tejas, the sattva principle maintains the cosmic memory of the entire creation- the collective memory of every human- each individual�s memory accumulated from the beginning of time through each rebirth until the present time i.e.� our personal wisdom.

*all the above mentioned doshas will be explained in detail in the coming chapter (tridosh)The Panchamahabhutas

As mentioned earlier the three primordial forces (sattva, rajas & tamas) interweave to create the five elements (panchmahabhutas) which birth the entire creation.

According to Ayurveda everything in life is composed of the Panchamahabhutas � Akash (Space), Vayu (Air), Jal (Water), Agni (Fire) and Prithvi (Earth). Omnipresent, they are mixed in an infinite variety of relative proportions such that each form of matter is distinctly unique. Constantly changing and interacting with each other, they create a situation of dynamic flux that keeps the world going.

This is a small example: Within a simple, single living cell for example the earth element predominates by giving structure to the cell. The water element is present in the cytoplasm or the liquid within the cell membrane. The fire element regulates the metabolic processes regulating the cell. While the air element predominates the gases therein. The space occupied by the cell denoting the last of the elements.

In the case of a complex, multi-cellular organism as a human being for instance, akash (space) corresponds to spaces within the body (mouth, nostrils, abdomen etc.); vayu (air) denotes the movement (essentially muscular); agni (fire) controls the functioning of enzymes (intelligence, digestive system, metabolism); jal (water) is in all body fluids (as plasma, saliva, digestive juices); and prithvi (earth) manifests itself in the solid structure of the body (bones, teeth, flesh, hair et al).

The Panchmahabhutas therefore serve as the foundation of all diagnosis treatment modalities in Ayurveda and has served as a most valuable theory for physicians to detect and treat illness of the body and mind successfully. For example, if a person has more of the fire element in the body he may suffer from more acid secretion (gastric/ digestive), which if causing harm in the form of hyperacidity etc., can be controlled by giving him food which contains more of jala (water) mahabhuta in it like sugarcane juice etc. �� (back to content)

1.2.6.4 Yoga Therapy: An Overview ^�

�Yoga Chikitsa is virtually as old as Yoga itself, indeed, the �return of mind that feels separated from the Universe in which it exists� represents the first Yoga therapy. Yoga Chikitsa could be termed as �man�s first attempt at unitive understanding of mind-emotions-physical distress and is the oldest wholistic concept and therapy in the world.� - Yogamaharishi Dr. Swami Gitananda Giri, ICYER at Ananda Ashram, Pondicherry.

Yoga may be said to be as ancient as the universe itself, since it is said to have been originated by Hiranyagarba, the causal germ plasm itself. This timeless art and science of humanity sprouted from the fertile soil of Sanathana Dharma, the traditional pan-Indian culture that continues to flourish into modern times.

Today, Yoga has become popular as a therapy, and most people come to it seeking to alleviate their physical, mental and emotional imbalances. We must understand, however, that the use of Yoga as a therapy is a much more recent happening in the wonderful long history of Yoga�which has historically served to promote spiritual evolution. Yoga helps unify all aspects of our very being: the physical body, in which we live our daily life; the energy body, without which we will not have the capacity to do what we do; the mind body, which enables us to do our tasks with mindfulness; the higher intellect, which gives us clarity; and, finally, the universal body, which gives us limitless bliss. �

All aspects of our life--physical, energetic, mental, intellectual and universal--are unified through the practice of Yoga, which may also be described as the science of right-use-ness, that is, of using our body, emotions, and mind responsibly and in the most appropriate manner. One of the best definitions of Yoga given by Swami Gitananda Giri is that it is a �way of life�. It is not something you do for 5 minutes a day or 20 minutes a day. It is indeed a 24 � 7 � 365. lifestyle.

Illness, disease and disorders are so common in this world, and people everywhere are desperately seeking relief from their suffering. Yoga helps us to think better and to live better; indeed, it helps us improve ourselves in everything we do. Hence it holds out the promise of health, well-being and harmony. According to the Bhagavad Gita, an ancient text which can be said to be a Yoga Shastra (seminal textual source of Yoga), Lord Krishna the Master of Yoga (Yogeshwar) defines Yoga as �dukkhasamyogaviyogam yoga samjnitham� meaning thereby that Yoga is the disassociation from the union with suffering. Pain, suffering, disease - Yoga offers a way out of all of these.

One of the foremost concepts of Yoga therapy is that the mind, which is called adhi, influences the body, thus creating vyadhi, the disease. (Fig 1)

This is known as the adhi vyadhi or adhija vyadhi, where the mind brings about the production of disease in the physical body. In modern language, this is called psychosomatic illness. Virtually every health problem that we face today either has its origin in psychosomatics or is worsened by the psychosomatic aspect of the disease. The mind and the body seem to be continuously fighting each other.

What the mind wants, the body won�t do, and what the body wants, the mind won�t do. This creates a dichotomy, a disharmony, in other words, a disease.

Yoga helps restore balance and equilibriumby virtue of the internal process of unifying mind, body and emotions. The psychosomatic stress disorders that are so prevalent in today�s world can be prevented, controlled and possibly even cured via the sincere and dedicated application of Yoga as a therapy.

Psychosomatic disorders go through four major phases. The first is the psychic phase, in which the stress is located essentially in the mind. There is jitteriness, a sense of unnatural tension, a sense of not being �at ease�.

If the stress continues, the psychic stage then evolves into the psychosomatic stage. At this point, the mind and body are troubling each other and fluctuations, such as a dramatic rise in blood pressure, blood sugar or heart rate, begin to manifest intermittently. If this is allowed to continue, one reaches the somatic stage, where the disease settles down in the body and manifests permanently. At this stage, it has become a condition that requires treatment and therapy. In the fourth, organic stage, the disease settles permanently into the target organs. This represents the end stage of the disease.

Yoga as a therapy works very well at both the psychic and psychosomatic stages. Once the disease enters the somatic stage, Yoga therapy as an adjunct to other therapies may improve the condition. In the organic stage, Yoga therapy�s role is more of a palliative, pain relieving and rehabilitative nature. Of course the major role of Yoga is as a preventive therapy, preventing that which is to come. Maharishi Patanjali tells us in his Yoga Darshan, �heyamdukkhamanagatham�-prevent those miseries that are yet to come�. �

If the practice of Yoga is taken up during childhood, we can prevent so many conditions from occurring later on in life. This is primary prevention. Once the condition occurs, once the disease has set in, we have secondary prevention, which is more in the nature of controlling the condition to whatever extent we can. Tertiary prevention is done once the condition has occurred, as we try to prevent the complications, those that affect the quality, and even the quantity, of a patient�s life.

When we use Yoga as a therapy, we need to consider both the nature of the person�his or her age, gender and physical condition�and the nature and stage of the disorder. A step-by-step approach must include a detailed look at all aspects of diet, necessary lifestyle modifications, attitude reconditioning through Yogic counseling, as well as the appropriate practices. All of these are integral components of holistic, or rather, wholesome Yoga therapy. When such an approach is adopted, tremendous changes will manifest in the lives of the patients and their families. The quality of life improves drastically and, in many cases, so does the quantity.

As human beings, we fulfill ourselves best when we help others. Yoga is the best way for us to consciously evolve out of our lower, sub-human nature, into our elevated human and humane nature. Ultimately, this life giving, life enhancing and life sustaining science of humanity allows us to achieve in full measure the Divinity that resides within each of us.

I would like to conclude this overview of Yoga therapy with a word of caution. Yoga therapy is not a magic therapy! It is not a �one pill for all ills�. There should be no false claims or unsubstantiated tall claims made in this field. Yoga therapy is also a science and must therefore be approached in a scientific, step-bystep manner. It should be administered primarily as a �one on one� therapy that allows the therapist to modify the practices to meet the needs of the individual. It is not a �one size fits all� or �one therapy fits all� approach!

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1.2.6.5 Siddha medicine ^w

Siddha medicine is a traditional medicine originating in Southern India. It is one of the oldest systems of medicine in India.

In rural India, siddhars have learned methods traditionally through master-disciple relationships to become local "healers". Siddhars are among an estimated 400,000 traditional healers practicing medicine in India, comprising some 57% of rural medical care. Siddha practitioners believe that five basic elements � earth, water, fire, air, sky � are in food, "humours" of the human body, and herbal, animal or inorganic chemical compounds, such as sulfur and mercury, used as therapies for treating diseases.

The Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy of the Government of India regulates training in Siddha medicine and other traditional practices grouped collectively as AYUSH. Practitioners are called siddhars (vaithiyars in Tamil), and may have formal training with advanced degrees, such as BSMS (Bachelor in Siddha Medicine and Surgery), MD (Medical Doctor, Siddha) or Doctor of Philosophy (PhD). The Central Council of Indian Medicine, a statutory body established in 1971 under AYUSH, monitors education in areas of rural Indian medicine, including Siddha medicine. The Indian Medical Association regards Siddha medicine degrees as "fake" and Siddha therapies as quackery, posing a danger to national health due to absence of training in science-based medicine. Identifying fake medical practitioners without qualifications, the Supreme Court of India stated in 2018 that "unqualified, untrained quacks are posing a great risk to the entire society and playing with the lives of people without having the requisite training and education in the science from approved institutions".

HISTORY

Siddha is an ancient Indian traditional treatment system which evolved in South India, and is dated to the times of 3rd millennium BCE Indus Valley Civilization or earlier. According to ancient literature of Siddha, it is said that the system of this medicine originated from Hindu God Shiva who taught it to his consort Parvati. Parvati then passed it on to Nandi and Nandi taught about it to nine Devtas.

Though the origin of this system is considered to be divine, Siddhar Agasthyar is considered as the founding father of this medical system. There are 18 prominent siddhars who are the main contributors to this system of medicine. The original texts and treatise for siddha are written in Tamil language.

CONCEPT OF DISEASE AND CAUSE

When the normal equilibrium of the three humors � Vaadham, Pittham and Kapam � is disturbed, disease is caused. The factors assumed to affect this equilibrium are environment, climatic conditions, diet, physical activities, and stress. Under normal conditions, the ratio between Vaadham, Pittham, and Kapam are 4:2:1, respectively.

According to the Siddha medicine system, diet and lifestyle play a major role in health and in curing diseases. This concept of the Siddha medicine is termed as pathiyam and apathiyam, which is essentially a rule based system with a list of "do's and don'ts".

HERBALISM

The herbal agents used by the siddhars could be classified into three groups: thavaram (herbal product), thadhu (inorganic substances) and jangamam (animal products). The thadhu agents are further classified as: uppu (water-soluble inorganic substances that give out vapour when put into fire), pashanam (agents not dissolved in water but emit vapour when fired), uparasam (similar to pashanam but differ in action), loham (not dissolved in water but melt when fired), rasam (substances which are soft), and ghandhagam (substances which are insoluble in water, like sulphur).

SIDDHA TODAY

The Tamil Nadu state runs a 5.5-year course in Siddha medicine (BSMS: Bachelor in Siddha Medicine and Surgery). The Indian Government also gives its focus on Siddha, by starting up medical colleges and research centers like National Institute of Siddha. and Central Council for Research in Siddha. Commercially, Siddha medicine is practiced by siddhars referred in Tamil as vaithiyars.

Practicing Siddha medicine and similar forms of rural alternative medicine in India was banned in the Travancore-Cochin Medical Practitioners' Act of 1953, then reinforced in 2018 by the Supreme Court of India which stated that "A number of unqualified, untrained quacks are posing a great risk to the entire society and playing with the lives of people." The Act requires that qualified medical practitioners be trained at a recognized institution, and be registered and displayed on a list of valid physician practitioners, as published annually in The Gazette of India. The Gazette list does not recognize practitioners of Siddha medicine because they are not trained, qualified or registered as valid physicians.

Since 2014, the Supreme Court of India and Indian Medical Association have described Siddha medicine as quackery, and there is no governmental recognition of siddhars as legitimate physicians. The Indian Medical Association regards the Indian institutions that train people in Siddha medicine, the supposed degrees granted, and the graduates of those programs as "fake". Since 1953, the Indian national government has not recognized Siddha medicine or any alternative system of medicine as valid, and there is no proposal to integrate Siddha medicine into conventional medicine practiced in India.

There may be as many as one million quack "doctors", including siddhars, practicing medicine in the rural regions of India, a condition not actively opposed by the Indian government out of concern for serving some health needs for the large rural population. The Indian Medical Association emphatically opposed this position in 2014. In 2018, licensed Indian physicians staged demonstrations and accused the government of sanctioning quackery by proposing to allow rural quacks to practice some aspects of clinical medicine without having complete medical training.

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1.2.7 Thai massage ^w

Thai massage or Thai yoga massage is a traditional therapy combining acupressure, Indian Ayurvedic principles, and assisted yoga postures. The idea of Sen-lines alias energy-lines was first used as "Thai yoga massage". These are similar to nadis as per the philosophy of yoga by Gorakhnath.

Nuad Thai, traditional Thai massage

UNESCO Intangible Cultural Heritage

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Thai massage

Country �� Thailand

Region �� Asia and the Pacific

Inscription history

Inscription �� 2019 (14th session)

List �� Representative

In the Thai language it is usually called nuat phaen thai (Thai: นวดแผนไทย, pronounced [n�a̯t pʰɛ̌ːn tʰāj]; lit. 'Thai-style massage') or nuat phaen boran (นวดแผนโบราณ, [n�a̯t pʰɛ̌ːn bōːrāːn]; lit. 'ancient-style massage'), though its formal name is nuat thai (นวดไทย, [n�a̯t tʰāj]; lit. 'Thai massage') according to the Traditional Thai Medical Professions Act, BE 2556 (2013).

The Thai Ministry of Public Health's Department for Development of Thai Traditional and Alternative Medicine regulates Thai traditional massage venues and practitioners. As of 2016 the department says 913 traditional clinics have registered nationwide in Thailand. As of 2018, of the 8,000 to 10,000 spa and massage shops in Thailand; only 4,228 are certified by the Health Ministry's Department of Health Service Support (HSS).

UNESCO added traditional Thai massage to its Cultural Heritage of Humanity list in December 2019.

Practice

The practice of Thai yoga massage is said to be thousands of years old, but it is still part of Thailand's medical system due to its perceived healing properties at both emotional and physical level. There are differences in certain practices associated with the massage when performed in the Western and Thai contexts. Western cultural sensibilities might be different in terms of accepting shamanic healing practices such as increasing the intensity of the massage or the giver jumping around the massage table like the Hindu god Hanuman. Traditional Thai massage uses no oils or lotions. The recipient remains clothed during a treatment. There is constant body contact between the giver and receiver, but rather than rubbing on muscles, the body is compressed, pulled, stretched and rocked. The concept of metta (loving kindness), based on Buddhist teachings, is an integral part of this practice. Well known practitioners also emphasize meditation and devotion on part of the practitioner as integral to the effectiveness of this practice.

The recipient wears loose, comfortable clothing and lies on a mat or firm mattress on the floor.

In Thailand, a dozen or so subjects may receive massage simultaneously in one large room. The true ancient style of the massage requires that the massage be performed solo with just the giver and receiver. The receiver will be positioned in a variety of yoga-like positions during the course of the massage, that is also combined with deep static and rhythmic pressures.

The massage generally follows designated lines ("sen") in the body. The legs and feet of the giver can be used to position the body or limbs of the recipient. In other positions, hands fix the body, while the feet do the massaging. A full Thai massage session may last two hours and includes rhythmic pressing and stretching of the entire body. This may include pulling fingers, toes, ears, cracking knuckles, walking on the recipient's back, by palm-press, thumb-press, fingers-press and forearm-press in many different positions including HDS. There is a standard procedure and rhythm to the massage, which the giver will adjust to fit the receiver.

History

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Drawings of acupressure points on sen lines at Wat Pho Temple, Phra Nakhon district, Bangkok

The founder of Thai massage and medicine is said to have been Chiwaka Komaraphat (ชีวกโก มารภัจจ์ Jīvaka Komarabhācca), who is said in the Pāli Buddhist canon to have been the Buddha's physician over 2,500 years ago. He is recorded in ancient documents as having extraordinary medical skills, his knowledge of herbal medicine, and for having treated important people of his day, including the Buddha himself.

In fact, the history of Thai massage is more complex than this legend of a single founder would suggest. Thai massage, like Thai traditional medicine (TTM) more generally, is a combination of influences from Indian and Southeast Asian traditions of medicine, and the art as it is practiced today is likely to be the product of a 19th-century synthesis of various healing traditions from all over the kingdom. Even today, there is considerable variation from region to region across Thailand, and no single routine or theoretical framework that is universally accepted among healers.

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1.2.8 Japan ^w

Kampo

Kanpō medicine (漢方医学, Kanpō igaku), often known simply as Kanpō (漢方, Chinese [medicine]), is the study of traditional Chinese medicine in Japan following its introduction, beginning in the 7th century. then adapted and modified to suit Japanese culture and traditions. Traditional Japanese medicine (TJM) uses most of the Chinese therapies including acupuncture, moxibustion, traditional Chinese herbology and traditional food therapy.

Kampo

Japanese name

Kanji�� 漢方医学

Transcriptions

Romanization �� Kanpō igaku

Chinese name

Traditional Chinese �� 日本漢方醫學

Simplified Chinese �� 日本汉方医学

Literal meaning �� "Han [Chinese] medicine in Japan"

Transcriptions

Standard Mandarin

Hanyu Pinyin �� R�běn H�nfāng yīxu�

Yue: Cantonese

Yale Romanization �� Yaht-b�n Hon-fōng yī-hohk

Shennong (Japanese: Shinnō) tasting herbs to ascertain their qualities (19th-century Japanese scroll)

Manase Dōsan (1507�94) who laid the foundations for a more independent Japanese medicine

Origins

According to Chinese mythology, the origins of traditional Chinese medicine are traced back to the three legendary sovereigns Fuxi, Shennong and Yellow Emperor. Shennong is believed to have tasted hundreds of herbs to ascertain their medicinal value and effects on the human body and help relieve people of their sufferings. The oldest written record focusing solely on the medicinal use of plants was the Shennong Ben Cao Jing which was compiled around the end of the first century B.C. and is said to have classified 365 species of herbs or medicinal plants. Chinese medical practices were introduced to Japan during the 6th century A.D. In 608, Empress Suiko dispatched E-Nichi, Fuku-In and other young physicians to China. It is said that they studied medicine there for 15 years. Until 838, Japan sent 19 missions to Tang China. While the Manase Dōsan (1507�94) who laid the foundations for a more independent Japanese medicine History officials studied Chinese government structures, physicians and many of the Japanese monks absorbed Chinese medical knowledge.

Early Japanese adaptation

In 702 A.D., the Taihō Code was promulgated as an adaptation of the governmental system of China's Tang Dynasty. One section called for the establishment of a university (daigaku) including a medical school with an elaborate training program, but due to incessant civil war this program never became effective. Empress Kōmyō (701�760) established the Hidenin and Seyakuin in the Kōfuku-Temple (Kōfuku-ji) in Nara, being two Buddhist institutions that provided free healthcare and medicine for the needy. For centuries to come Japanese Buddhist monks were essential in conveying Chinese medical know-how to Japan and in providing health care for both the elite and the general population.

In 753 A.D., the Chinese priest Jianzhen (in Japanese Ganjin), who was well-versed in medicine, arrived in Japan after five failed attempts in 12 years to cross the East China Sea. As he was blind, he used his sense of smell to identify herbs. He brought medical texts and a large collection of materia medica to the imperial palace in Nara, which he dedicated to the Emperor Shōmu in 756, 49 days after the emperor's death. They are kept in a log-cabin-style treasure house of the Tōdai-Temple (Tōdai-ji) known as Shōsōin.

In 787 A.D., the "Newly Revised Materia Medica" (Xinxiu Bencao, 659 A.D.), which had been sponsored by the Tang Imperial Court, became an obligatory text in the study of medicine at the Japanese Health Ministry, but many of the 844 medicinal substances described in this book were not available in Japan at the time. Around 918 A.D., a Japanese medical dictionary entitled "Japanese names of (Chinese) Materia Medica" (Honzō-wamyō) was compiled, quoting from 60 Chinese medical works.

During the Heian Period, Tanba Yasuyori (912�995) compiled the first Japanese medical book, Ishinpō ("Prescriptions from the Heart of Medicine"), drawing from numerous Chinese texts, some of which have perished later. During the period from 1200 to 1600, medicine in Japan became more practical. Most of the physicians were Buddhist monks who continued to use the formulas, theories and practices that had been introduced by the early envoys from Tang China.

EARLY REVISION

During the 15th and 16th centuries, Japanese physicians began to achieve a more independent view on Chinese medicine. After 12 years of studies in China Tashiro Sanki (1465�1537) became the leading figure of a movement called "Followers of Later Developments in Medicine" (Gosei-ha). This school propagated the teachings of Li Dongyuan and Zhu Tanxi that gradually superseded the older doctrines from the Song dynasty. Manase Dōsan, one of his disciples, adapted Tashiro's teachings to Japanese conditions. Based on his own observation and experience, he compiled a book on internal medicine in eight volumes (Keiteki-shū) and established an influential private medical school (Keiteki-in) in Kyōto. His son Gensaku wrote a book of case studies (Igaku tenshō-ki) and developed a considerable number of new herb formulas.

From the second half of the 17th century, a new movement, the "Followers of Classic Methods" (Kohō-ha), evolved, which emphasized the teachings and formulas of the Chinese classic "Treatise on Cold Damage Disorders" (Shanghan Lun, in Japanese Shōkan-ron). While the etiological concepts of this school were as speculative as those of the Gosei-ha, the therapeutic approaches were based on empirical observations and practical experience. This return to "classic methods" was initiated by Nagoya Gen'i (1628�1696), and advocated by influential proponents such as Gotō Gonzan (1659�1733), Yamawaki Tōyō (1705�1762), and Yoshimasu Tōdō (1702�1773). Yoshimasu is considered to be the most influential figure. He accepted any effective technique, regardless of its particular philosophical background. Yoshimasu's abdominal diagnostics are commonly credited with differentiating early modern Traditional Japanese medicine (TJM) from Traditional Chinese medicine (TCM).

During the later part of the Edo period, many Japanese practitioners began to utilize elements of both schools. Some, such as Ogino Gengai (1737�1806), Ishizaka Sōtetsu (1770�1841), or Honma Sōken (1804�1872), even tried to incorporate Western concepts and therapies, which had made their way into the country through physicians at the Dutch trading-post Dejima (Nagasaki). Although Western medicine gained some ground in the field of surgery, there was not much competition between "Eastern" and "Western" schools until the 19th century, because even adherents of "Dutch-Studies" (Rangaku) were very eclectic in their actual practice.

Traditional medicine never lost its popularity throughout the Edo period, but it entered a period of rapid decline shortly after the Meiji Restoration. In 1871, the new government decided to modernize medical education based on the German medical system. Starting in 1875, new medical examinations focused on natural sciences and Western medical disciplines. In October 1883, a law retracted the licenses of any existing traditional practitioner. Despite losing legal standing, a small number of traditional physicians continued to practice privately. Some of them, such as Yamada Gyōkō (1808�1881), Asada Sōhaku (1813�1894), and Mori Risshi (1807� 1885), organized an "Association to Preserve [Traditional] Knowledge" (Onchi-sha) and started to set up small hospitals. However, by 1887, the organization was disbanded due to internal policy dissent and the death of leading figures. The "Imperial Medical Association" (Teikoku Ikai), founded in 1894, was short-lived too. In 1895, the 8th National Assembly of the Diet vetoed a request to continue the practice of Kampō. When Azai Kokkan (1848�1903), one of the main activists, died, the Kampō movement was almost stamped out.

ERA OF WESTERN INFLUENCE

Any further attempt to save traditional practices had to take into account Western concepts and therapies. Therefore, it was graduates from medical faculties, trained in Western medicine, who began to set out to revive traditional practices. In 1910, Wada Keijūrō (1872�1916) published "The Iron Hammer of the Medical World" (Ikai no tettsui). Yumoto Kyūshin (1876�1942), a graduate from Kanazawa Medical School, was so impressed by this book that he became a student of Dr. Wada. His "Japanese-Chinese Medicine" (Kōkan igaku), published in 1927, was the first book on Kampō medicine in which Western medical findings were used to interpret classical Chinese texts. In 1927, Nakayama Tadanao (1895�1957) presented his "New Research on Kampō-Medicine" (Kampō-igaku no shin kenkyū). Another "convert" was Ōtsuka Keisetsu (1900�1980), who became one of the most famous Kampō practitioners of the 20th century.

This gradual revival was supported by the modernization of the dosage form of herbal medicine.

During the 1920s, the Nagakura Pharmaceutical Company in Osaka began developing dried decoctions in a granular form. At about the same time, Tsumura Juntendō, a company founded by Tsumura Jūsha (1871�1941) in 1893, established a research institute to promote the development of standardized Kampō medicine. Gradually, these "Japanese-Chinese remedies" (wakan-yaku) became a standard method of Kampō medicine administration.

In 1937, new researchers such as Yakazu Dōmei (1905�2002) started to promote Kampō at the so-called "Takushoku University Kampo Seminar". More than 700 people attended these seminars that continued after the war. In 1938, following a proposal of Yakazu, the "Asia Medicine Association" was established. In 1941, Takeyama Shinichirō published his "Theories on the Restoration of Kampō Medicine" (Kampō-ijutsu fukkō no riron, 1941). In that same year, Yakazu, Ōtsuka, Kimura Nagahisa, and Shimizu Fujitarō (1886�1976) completed a book entitled "The Actual Practice of Kampō Medicine" (Kampō shinryō no jissai). By including Western medical disease names he greatly expanded the usage of Kampō formulas. A new version of this influential manual was printed in 1954. This book was also translated into Chinese. A completely revised version was published in 1969 under the title "Medical Dictionary of Kampō Practice" (Kampō Shinryō Iten).

In 1950, Ōtsuka Keisetsu, Yakazu Dōmei, Hosono Shirō (1899�1989), Okuda Kenzō (1884�1961), and other leaders of the pre- and postwar Kampō revival movement established the "Japan Society for Oriental Medicine" (Nippon Tōyō Igakkai) with 89 members (2014: more than 9000 members). In 1960, raw materials for crude drugs listed in the Japanese Pharmacopoeia (Nippon Yakkyoku-hō) received official drug prices under the National Health Insurance (NHI, Kokumin kenkō hoken).

Today in Japan, Kampō is integrated into the Japanese national health care system. In 1967, the Ministry of Health, Labour and Welfare approved four Kampō medicines for reimbursement under the National Health Insurance (NHI) program. In 1976, 82 kampo medicines were approved by the Ministry of Health, Labour and Welfare. This number has increased to 148 Kampo formulation extracts, 241 crude drugs, and 5 crude drug preparations.

Rather than modifying formulae as in Traditional Chinese medicine, the Japanese Kampō tradition uses fixed combinations of herbs in standardized proportions according to the classical literature of Chinese medicine. Kampō medicines are produced by various manufacturers.

However, each medicine is composed of exactly the same ingredients under the Ministry's standardization methodology. The medicines are therefore prepared under strict manufacturing conditions that rival pharmaceutical companies. In October 2000, a nationwide study reported that 72% of registered physicians prescribe Kampō medicines. New Kampō medicines are being evaluated using modern techniques to evaluate their mechanism of action.

The 14th edition of the Japanese Pharmacopoeia (JP, Nihon yakkyokuhō) lists 165 herbal ingredients that are used in Kampō medicines. Lots of the Kampō products are routinely tested for heavy metals, purity, and microbial content to eliminate any contamination. Kampō medicines are tested for the levels of key chemical constituents as markers for quality control on every formula. This is carried out from the blending of the raw herbs to the end product according to the Ministry's pharmaceutical standards.

Approved Kampō medicines

Herbs

Medicinal mushrooms like Reishi and Shiitake are herbal products with a long history of use. In Japan, the Agaricus blazei mushroom is a highly popular herb, which is used by close to 500,000 people. In Japan, Agaricus blazei is also the most popular herb used by cancer patients.

The second most used herb is an isolate from the Shiitake mushroom, known as Active Hexose Correlated Compound.

In the United States, Kampō is practiced mostly by acupuncturists, Chinese medicine practitioners, naturopath physicians, and other alternative medicine professionals. Kampō herbal formulae are studied under clinical trials, such as the clinical study of Honso Sho-saiko-to (H09) for treatment of hepatitis C at the New York Memorial Sloan-Kettering Cancer Center, and liver cirrhosis caused by hepatitis C at the UCSD Liver Center. Both clinical trials are sponsored by Honso USA, Inc., a branch of Honso Pharmaceutical Co., Ltd., Nagoya, Japan.

One of the first sources showing the term "Kampō" in its modern sense (James Curtis Hepburn: A Japanese and English Dictionary; with an English and Japanese Index. London: Tr�bner & Co., 1867, p. 177.)

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1.2.8.1 Reiki ^w

Reiki (霊気, /ˈreɪki/) is a Japanese form of energy healing, a type of alternative medicine. Reiki practitioners use a technique called palm healing or hands-on healing through which a "universal energy" is said to be transferred through the palms of the practitioner to the patient in order to encourage emotional or physical healing.

Reiki

Chinese name

Traditional Chinese �� 靈氣

Simplified Chinese �� 灵气

Transcriptions

Standard Mandarin

Hanyu Pinyin �� l�ngq�

Wade�Giles �� ling2-ch'i4

Yue: Cantonese

Jyutping �� ling4-hei3

Vietnamese name

Vietnamese alphabet �� linh kh�

Korean name

Hangul �� 영기

Hanja �� 靈氣

Transcriptions

Revised Romanization �� yeonggi

McCune�Reischauer �� yŏngki

Japanese name

Hiragana �� れいき

Kyūjitai �� 靈氣

Shinjitai �� 霊気

Reiki is a pseudoscience, and is used as an illustrative example of pseudoscience in scholarly texts and academic journal articles. It is based on qi ("chi"), which practitioners say is a universal life force, although there is no empirical evidence that such a life force exists.

Clinical research does not show reiki to be effective as a treatment for any medical condition, including cancer, diabetic neuropathy, anxiety or depression; therefore, it should not replace conventional medical treatment. There is no proof of the effectiveness of reiki therapy compared to placebo. Studies reporting positive effects have had methodological flaws.

Etymology

Mikao Usui (1865�1926)

According to the Oxford English Dictionary, the English alternative medicine word reiki comes from Japanese reiki (霊気) "mysterious atmosphere, miraculous sign", combining rei "soul, spirit" and ki "vital energy"�the Sino-Japanese reading of Chinese l�ngq� (靈氣) "numinous atmosphere".

According to the inscription on his memorial stone, Mikao Usui taught his system of reiki to more than 2,000 people during his lifetime. While teaching reiki in Fukuyama, Usui suffered a stroke and died on 9 March 1926. The first reiki clinic in the United States was started by Chujiro Hayashi's student Hawayo Takata in 1970.

Basis

Reiki's teachings and adherents claim that qi is physiological and can be manipulated to treat a disease or condition. The existence of qi has not been established by medical research. Therefore, reiki is a pseudoscientific theory based on metaphysical concepts.

The existence of the proposed mechanism for reiki�qi or "life force" energy�has not been scientifically established. Most research on reiki is poorly designed and prone to bias. There is no reliable empirical evidence that reiki is helpful for treating any medical condition,

Chujiro Hayashi (1880�1940)

Origins

Research and critical evaluation although some physicians have said it might help promote general well-being. In 2011, William T. Jarvis of The National Council Against Health Fraud stated that there "is no evidence that clinical reiki's effects are due to anything other than suggestion" or the placebo effect.

The April 22, 2014, Skeptoid podcast episode titled "Your Body's Alleged Energy Fields" relates a reiki practitioner's report of what was happening as she passed her hands over a subject's body:

What we'll be looking for here, within John's auric field, is any areas of intense heat, unusual coldness, a repelling energy, a dense energy, a magnetizing energy, tingling sensations, or actually the body attracting the hands into that area where it needs the reiki energy, and balancing of John's qi.

Evaluating these claims scientific skeptic author Brian Dunning reported: ... his aura, his qi, his reiki energy. None of these have any counterpart in the physical world. Although she attempted to describe their properties as heat or magnetism, those properties are already taken by �well, heat and magnetism. There are no properties attributable to the mysterious field she describes, thus it cannot be authoritatively said to exist."

Scholarly evaluation

Reiki is used as an illustrative example of pseudoscience in scholarly texts and academic journal articles.

In criticizing the State University of New York for offering a continuing education course on reiki, one source stated, "reiki postulates the existence of a universal energy unknown to science and thus far undetectable surrounding the human body, which practitioners can learn to manipulate using their hands," and others said, "In spite of its [reiki] diffusion, the baseline mechanism of action has not been demonstrated ..." and, "Neither the forces involved nor the alleged therapeutic benefits have been demonstrated by scientific testing."

Several authors have pointed to the vitalistic energy which reiki is claimed to treat, with one saying, "Ironically, the only thing that distinguishes reiki from therapeutic touch is that it [reiki] involves actual touch," and others stating that the International Center for Reiki Training "mimic[s] the institutional aspects of science" seeking legitimacy but holds no more promise than an alchemy society.

A guideline published by the American Academy of Neurology, the American Association of

Neuromuscular & Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation states, "Reiki therapy should probably not be considered for the treatment of PDN [painful diabetic neuropathy]." Canadian sociologist Susan J. Palmer has listed reiki as among the pseudoscientific healing methods used by cults in France to attract members.

Evidence quality

A 2008 systematic review of nine randomized clinical trials found several shortcomings in the literature on reiki. Depending on the tools used to measure depression and anxiety, the results varied and were not reliable or valid. Furthermore, the scientific community has been unable to replicate the findings of studies that support reiki. The review also found issues in reporting methodology in some of the literature, in that often there were parts omitted completely or not clearly described. Frequently in these studies, sample sizes were not calculated and adequate allocation and double-blind procedures were not followed. The review also reported that such studies exaggerated the effectiveness of treatment and there was no control for differences in experience of reiki practitioners or even the same practitioner at times produced different outcomes. None of the studies in the review provided a rationale for the treatment duration and no study reported adverse effects.

Safety

Safety concerns for reiki sessions are very low and are akin to those of many complementary and alternative medicine practices. Some physicians and health care providers, however, believe that patients may unadvisedly substitute proven treatments for life-threatening conditions with unproven alternative modalities including reiki, thus endangering their health.

Catholic Church concerns

In March 2009, the Committee on Doctrine of the United States Conference of Catholic Bishops issued the document Guidelines for Evaluating Reiki as an Alternative Therapy, in which they declared that the practice of reiki was based on superstition, being neither truly faith healing nor science-based medicine. They stated that reiki was incompatible with Christian spirituality since it involved belief in a human power over healing rather than prayer to God, and that, viewed as a natural means of healing, it lacked scientific credibility. The 2009 guideline concluded that "since reiki therapy is not compatible with either Christian teaching or scientific evidence, it would be inappropriate for Catholic institutions, such as Catholic health care facilities and retreat centers, or persons representing the Church, such as Catholic chaplains, to promote or to provide support for reiki therapy." Since this announcement, some Catholic lay people have continued to practice reiki, but it has been removed from many Catholic hospitals and other institutions.

In a December 2014 article from the USCCB's Committee on Divine Worship on exorcism and its use in the Church, reiki is listed as a practice "that may have [negatively] impacted the current state of the afflicted person".

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1.2.9 Rolfing ^w

Rolfing (/ˈrɔːlfɪŋ, ˈrɒl-/) is a form of alternative medicine originally developed by Ida Rolf (1896�1979) as Structural Integration. Rolfing is marketed with unproven claims of various health benefits. It is based on Rolf's ideas about how the human body's "energy field" can benefit when aligned with the Earth's gravitational field.

Rolfing is typically delivered as a series of ten hands-on physical manipulation sessions sometimes called "the recipe". Practitioners combine superficial and deep manual therapy with movement prompts. The process is sometimes painful. The safety of Rolfing has not been confirmed.

The principles of Rolfing contradict established medical knowledge, and there is no good evidence Rolfing is effective for the treatment of any health condition. It is recognized as a pseudoscience and has been characterized as quackery.

Science writer Edzard Ernst offers this definition: "Rolfing is a system of bodywork invented byIda Pauline Rolf (1896�1979) employing deep manipulation of the body's soft tissue allegedly to realign and balance the body's myofascial structures."

Rolfing is based on the unproven belief that such alignment results in improved movement, breathing, pain reduction, stress reduction, and even emotional changes.

Conceptual basis

Rolf described the body as organized around an axis perpendicular to the earth, pulled downward by gravity, and she believed the function of the body was optimal when it was aligned with that pull. In her view, gravity tends to shorten fascia, leading to disorder of the body's arrangement around its axis and creating imbalance, inefficiency in movement, and pain.

Rolfers aim to lengthen the fascia in order to restore the body's arrangement around its axis and facilitate improved movement. Rolf also discussed this in terms of "energy" and said:

Rolfers make a life study of relating bodies and their fields to the earth and its gravity field, and we so organize the body that the gravity field can reinforce the body's energy field. This is our primary concept.

The manipulation is sometimes referred to as a type of bodywork, or as a type of massage. Some osteopaths were influenced by Rolf, and some of her students became teachers of massage, including one of the founders of myofascial release.

Rolf claimed to have found an association between emotions and the soft tissue, writing "although rolfing is not primarily a psychotherapeutic approach to the problems of humans", it does constitute an "approach to the personality through the myofascial collagen components of the physical body". She claimed Rolfing could balance the mental and emotional aspects of subjects, and that "the amazing psychological changes that appeared in Rolfed individuals were completely unexpected". Rolfers suggest their manipulations can cause the release of painful repressed memories. Rolfers also hold that by manipulating the body they can bring about changes in personality; for example, teaching somebody to walk with confidence will make them a more confident person. The connection between physical structure and psychology has not been proven by scientific studies.

History

Ida Rolf began working on clients in New York City in the 1940s with the premise that the human structure could be organized "in relation to gravity". She developed structural integration with one of her sons and by the 1950s she was teaching her work across the United States. In the mid-1960s she began teaching at Esalen Institute, where she gathered a loyal following of students and practitioners.[35] Esalen was the epicenter of the Human Potential Movement, allowing Rolf to exchange ideas with many of their leaders, including Fritz Perls. Rolf Effectiveness and reception incorporated a number of ideas from other areas including osteopathic manipulation, cranial osteopathy, hatha yoga, and the general semantics of Alfred Korzybski. In 1971 she founded the Rolf Institute of Structural Integration. The school has been based in Boulder, Colorado, since 1972, and as of 2010 included five institutes worldwide.

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1.2.10 Greco-Roman Medicine ^w

Greek medicine derived its earliest beliefs and practices from Egypt and West Asia. Greek medicine later spread around the Mediterranean during Roman times and was to form the basis of the medical knowledge of Medieval Europe. Our knowledge of Greek medicine mainly comes from the Hippocratic writings and from Galen writing in the second century CE.

The earliest Greek medicine was based on religion. Asclepius, the son of Apollo, was able to cure disease and patients sleeping at his shrines would see the God in their dreams and receive advice on appropriate treatments. Around the sixth century BCE Greek medicine began to change with a greater emphasis on rational explanations of disease involving natural rather than supernatural causes. The Hippocratic writings, probably written by a number of authors, suggested liquids were the vital element in all living things. The human body contained four fluids or humors, phlegm, yellow bile, black bile and blood. Disease was caused by an imbalance of these fluids in the body. Such an imbalance could be caused by the weather or by extreme behaviour such as over eating or excessive drinking. The medical practice of bleeding, which was to persist for several thousand years, originated from the belief there was an excess of blood which could be cured by releasing some blood from the body. Correct diet, bathing, exercise, sleep and sex would prevent illness. According to Hippocrates sex should be more frequent in winter and older men should have sex more frequently than younger men. He considered epilepsy was caused by an excess of phlegm. Hippocrates however tells us little about infectious diseases and anatomy as the dissection of bodies was taboo as it was considered to be a violation of the sanctity of the human body.

The classical era taboo on human dissection led to some quite erroneous views of the human body. Aristotle considered the heart was where the soul was located and was the center of thought, sense perception and controlled bodily movements. He considered the brain cooled the heart and the blood. There was however a brief period in Alexandria where due to the ancient Egyptian practice of embalming and the more recent Platonic view that the soul and not the body, was sacred, human dissection was allowed. Herophilus and Erasistratus carried out dissections that led them to discover the nerves leading to the brain. They discovered there were two different types of nerves, one, dealing with sense perception and the other with body movement. When studying the brain, they discovered the cerebrum and the cerebellum and suggested the heavily folded human brain indicated humans� higher intelligence compared to animals. They considered the lungs took in air that was then transferred to the arteries, the veins held blood and the heart worked like a bellows. After making significant discoveries that could only be made by human dissection, the taboo against dissection rose again delaying further progress until the 16th century. Until then, knowledge of the interior of the human body could only be guessed at from its external behaviour or by comparison with animal anatomy.

Two further theories created by the ancient Greeks were the methodic theory and the pneumatic theory. The methodic theory considered disease to be caused by a disturbance of atoms in the body and treatment involved manipulating the body by massage, bathing or exercise. The pneumatic theory considered breath to be a crucial factor in human health.

The high point of Greco-Roman medical knowledge came with Galen in the second century CE. Galen�s two main areas of study were anatomy and physiology. As human dissection was illegal his anatomical studies were based on dissections of animals, particularly the Barbary ape. He did however have the assistance of his study of gladiator�s wounds, a human skeleton he had seen in Alexandria and of human bodies exhumed by natural events, such as floods. Galen�s work on the bone structure and muscular system were a significant advance on anything else in antiquity. His belief in Aristotle�s idea that everything had a purpose led him to assume every bone, muscle and organ had a particular function and he set out to describe each bone, muscle and organ and their particular function. He described the human skeleton and muscular system with some accuracy. He put an end to Aristotle�s idea that the mind was located in the heart, locating it in the brain. Galen discovered seven pairs of cranial nerves, the sympathetic nervous system and he distinguished between the sensory and motor nerves. However, he also found things that did not exist. The rete mirabile (wonderful network) is located under the brain of many hoofed animals but is not found in humans. Yet Galen�s claim that it exists in humans was accepted for some thirteen centuries.

Galen�s physiology, his concept of how the human body worked, began with a vital spirit, pneuma taken into the body by breathing. The pneuma entered the lungs where it met some blood before passing into the left ventricle of the heart. The blood then flowed into the arteries and spread through the body feeding the flesh. When food entered the body it converted into blood in the liver, some of the blood then entered the veins and spread through the body and was feed into the flesh. Other blood flowed from the liver into the right ventricle of the heart from where some of the blood entered the lungs to absorb the pneuma. Some of the blood in the right ventricle however passed directly into the left ventricle and from there flowed into the arteries. One problem for Galen, was that he was unable to discover how blood moved from the right ventricle to the left ventricle, which were divided by a solid muscular wall. He eventually concluded there must be tiny holes in the wall, so small they could not be seen by the human eye. Galen�s system correctly realized the heart caused blood to flow through the body and that the arteries contained blood. Previously Erasistratus suggested the arteries only contained air, as the arteries of a dead body do not contain blood. Galen did not realize that the blood circulated and his suggestion of minute holes in the wall between the right and left ventricles of the heart was wrong.

Galen�s pathology, his concept of illness, brought together Hippocrates theory of the four humors and Aristotle�s idea of the four elements, air, fire, earth and water. Blood was considered to be warm and moist, yellow bile warm and dry, black bile cold and dry and phlegm cold and moist. Blood is associated with the heart, yellow bile with the liver, black bile with the spleen and phlegm with the brain. The following table shows how Galen brought the two ideas together.

Humor	Element	Organ	Qualities
Phlegm	Water	Brain	Cold & Wet
Blood	Air	Heart	Hot & Wet
Yellow bile	Fire	Liver	Hot & Dry
Black bile	Earth	Spleen	Dry & Cold

The table indicates the symptoms of the disease, the cause of the disease and the cure for the disease. If the patient has the symptom of being hot and perspiring, this is the quality of being hot and wet; this suggests there is an imbalance in the blood, so that bleeding is the cure. If they have a hot and dry fever, this suggests the yellow bile is out of balance, so that vomiting up the yellow bile is the cure. The humors could also affect a person�s personality. An excess of phlegm would make one phlegmatic, of blood, one would be sanguine, of yellow bile, one would be choleric and of black bile, one would be melancholic.

An imbalance in the humors in particular organs could result in illness. Excessive phlegm in the bowels resulted in dysentery and an excess in the lungs caused tuberculosis. Cancer was caused by a massive imbalance in the humors. Stroke was caused by an excess of blood, jaundice by excessive yellow bile and depression by too much black bile.

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1.2.10.1 Asahi Health ^w

Asahi (or Asahi Health) is a Finnish health exercise based on the eastern traditions of T'ai chi

ch'uan, qigong, yiquan and yoga, with a western scientific viewpoint. Asahi is designed to suit everybody, regardless of physical condition or age.

Asahi exercise is taught and performed in instructed groups, but Asahi can also be performed alone as a form of daily self-treatment. Asahi exercise is ideal for short breaks. This exercise is equally effective in a group or alone.

The History of Asahi

Asahi was created in Finland 2004 by professional sports instructors and martial artists Timo Klemola, Ilpo Jalamo, Keijo Mikkonen and Yrj� M�h�nen. They all had high regards towards classical body development techniques such as karate, T'ai chi ch'uan, yiquan and yoga, but these styles, as rewarding as they are, seemed to attract only a small marginal of the Finnish population.

These classical styles are quite complex and therefore may have a high starting level. They use concepts such as qi and prana, which may seem mystical to western people.

The purpose of Asahi was to get the best out of these techniques, put it in the most simplified form, make it overall scientific and turn it into an easily approachable form - a health exercise for everybody with no starting level at all.

Asahi is designed to treat and prevent shoulder- and back problems, fractures due to falling down and stress-related psychosomatic problems.

Asahi is a series of slow movements, completed in silence. It looks harmonious and beautiful, a bit like qigong.

The basic six principles of Asahi are:

1. The linking of movement and breath

2. Practicing vertically erect body alignment

3. Whole body movement

4. Listening to the slow motion

5. Cultivating the mind with mental images

6. The exercise as a continual, flowing experience The Asahi movements are soft and performed in the rhythm of breathing. The series is simple and easy to learn. The movements have also a practical function, for example picking up a ball from the floor or improving one�s balance by standing on one foot. Advanced levels are designed for long-term trainees, yet they are equally simple to learn.

The Principles of Asahi Distribution

Asahi can be practiced in major areas of Finland. Asahi Health Ltd has also been accepted as an Education Partner to Federation of International Sports, Aerobics and Fitness as the first Body Mind -product to be recognized and recommended by this organization. These exercises can be help my a teacher guiding a class, or through video instruction. Others that have experience can practice their own routine after learning from instruction.

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1.2.10.2 Biodanza ^w

Biodanza (a neologism jointed the Greek bio [life] and the Spanish danza, literally "the dance of life") is a system of self-development utilizing music, movement and positive feelings to deepen self-awareness. It seeks to promote the ability to make a holistic link to oneself and one's emotions and to express them. Practitioners believe that Biodanza opens the space for one to deepen the bonds with others and nature and to express those feelings in a congenial manner.

It was created in the 1960s by the Chilean anthropologist and psychologist Rolando Toro Araneda. The Biodanza system is now found in 54 countries, including Argentina, Belgium, Brazil, Chile, Colombia, Czech Republic, Ecuador, France, Germany, Israel, India, Italy, Netherlands, New Zealand, Norway, Portugal, Spain, Switzerland, United Kingdom, Uruguay, Venezuela, Australia, Japan, South Africa, United States, Ireland and Russia. Practitioners describe Biodanza as a "human integration system of organic renewal, of affective re-education, and of relearning of Life's original functions. Its application consists in leading vivencias through music, singing, movements and group encounter situations". Proponents claim it can be used to develop our human capacities, communication skills, and relationships, including the feeling of happiness.

Origins and popularity

Purpose and process

Biodanza has been featured on CNN Chile, on BBC TV and national newspapers in the UK, and in lifestyle magazines in the UK and South Africa.

The Daily Telegraph describes Biodanza as "a series of exercises and moves that aim to promote self-esteem, the joy of life and the expression of emotions. Lots of bounding around and hugs".

Following the death of its founder in February 2010, two governing bodies of Biodanza currently exist, by means of which students may receive official certificates. The International Biodanza Federation (IBF) governs the Biodanza system in Europe, Australia, New Zealand, the United States and Canada. The US has official schools located in San Francisco, Los Angeles and Maryland. The International Organization of Biodanza SRT governs the Biodanza system in South America.

1.2.10.3 Speleotherapy ^w

Speleotherapy (Greek σπήλαιον spḗlaion "cave") is an alternative medicine respiratory therapy involving breathing inside a cave.

Speleotherapy

History

Hippocrates believed that salt-based therapies, including inhaling steam from saltwater, provided relief of respiratory symptoms. There are claims of improvements in the breathing of miners in Roman times and medieval times. Speleotherapy hospitals existed in Italy in the 19th century. In the middle of the 19th century, a clinic, founded in Mammoth Cave (Kentucky, USA), was intended for tuberculosis patients. However, a few months after the death of five of the patients, the hospital was closed.

The history of modern speleotherapy dates back to the 1950s. At this time, speleotherapeutic hospitals arose in several Eastern and Central European countries.

Residents of Ennepetal in Germany used the Kluterth�hle cave as a bomb shelter during WW2.

Karl Hermann Spannagel began researching the therapeutic effect of caves.

Speleotherapeutic facilities in karst caves were started in Hungary and Czechoslovakia.

In 1968, in Solotvyn (now in Ukraine), the first speleotherapy clinic was opened on the territory of the USSR. In 1982, a climate chamber was patented, equipped with a salt filter-saturator to recreate the conditions of salt mines on the earth's surface.

Indications

The treatment is claimed to be used for bronchial asthma, bronchitis, allergic and chronic runny nose, allergic and chronic sinus diseases, various allergies and skin diseases, fibrosing alveolitis and croup. However, as of 2022, there is no evidence to support these claims.

Speleotherapy in the Czech Republic

The first speleotherapy in the Czechoslovakia was carried out by Mgr. �tefan Roda in Slovakia in the Tomba�ek Cave in the High Tatras (1969). In 1973-1976, doctors Timov� and Valtrov� from the Children's Clinic in Bansk� Bystrica treated childhood asthmatics with speleotherapy with favourable results, which were published in the medical literature. From 1981 to 1985, speleotherapy became the subject of official scientific research tasks, carried out under the responsibility of the Ministry of Health and the Geographical Institute of the Czechoslovak Academy of Sciences. In 1985, speleotherapy was recognized as an official climatic treatment method.

According to the chairman of the International Union of Speleology's Standing Commission on Speleotherapy, Prof. Svetozar Dluholucky, M.D., speleotherapy is "a natural way of treating asthma and allergies, which it would be a sin not to use." He has conducted research in Bystrianska Cave since 1974, according to which there has been a fivefold decrease in respiratory diseases and asthma in the children studied. In 1997, he conducted further research on 111 asthmatic children with the same results.

Allergists and immunologists remain sceptical, however.

There are two speleotherapy centres in the Czech Republic: the Children's Treatment Centre in Ostrov u Macochy and the Children's Treatment Centre for Respiratory Diseases in Zlat� Hory. The children's sanatorium in Mladč-Vojtěchov was closed in 2014.

Research

Hoyrm�r Malota led a research team that tested patients of the speleotherapeutic sanatorium in Mladeč in 1985-1987 and came to the clinically verified knowledge "that individual factors of the underground environment, or their complex connected by internal and external interactions, stimulate and modulate the immune system of the human organism directly. He confirmed that repeated exposure to the underground environment - without the use of anti-asthmatic, antihistamine, or immunomodulatory pharmaceutical preparations - induces positive and measurable changes in secretory and lymphatic lysosomes and immunoglobins after only a few days of exposure to the degree that any existing artificial immunomodulators cannot achieve."

Some factors characterizing cave endoclimates are controversial. While cave aerosols may theoretically contain high Ca and Mg ions, in practice, they are not present in the treatment sites known to date; Ca and Mg concentrations are everywhere the same as in the ambient air. It has been shown that the concentrations of Ca and Mg in cave air are not so significantly elevated as to be considered a therapeutic factor.

The elevated CO2 concentration, or the absence of allergens in the cave (the presence of some molds in very small amounts), or the absence of ozone is also questionable.

According to the Cochrane Collaboration, three studies involving 124 children with asthma met the inclusion criteria for the 2001 meta-study. Still, only one study was of adequate methodological quality. Two studies reported that speleotherapy had a beneficial short-term effect on lung function. The other results could not be reliably evaluated. Due to the small number of studies, no reliable conclusion can be drawn from the available evidence on whether speleotherapy interventions are effective in treating chronic asthma. Randomized controlled trials with long-term follow-up are needed.

No evidence of the effectiveness of speleotherapy was found from randomized controlled trials and further research is needed.

According to a 2017 Romanian systematic review, speleotherapy is a valuable treatment method for asthma and other respiratory problems. Still, only a few studies can be found in international databases, reflecting the specificity of this field. On the other hand, basic studies in laboratory animals and in vitro cell cultures have demonstrated the efficacy and usefulness of speleotherapy.

Quote

There are not so many karst caves, so salt mines have been used for treatment for a long time. So sanatoriums were created there, and it's called halotherapy. Wieliczka in Poland is very well known. Later on, there was an attempt to make halocaves artificially and they built a kind of igloo out of the salt that was mined. In various studies in the mid-1980s they compared the effect underground and in these salt chambers placed outside. It turned out that the above-ground salt caves had virtually no effect. And even, very easily contaminated with microbes, it can be dangerous. Many of the bacteria that causes severe respiratory infections love salt and settle in the surface layers of salt walls. Even salt mines that operate underground have very strict criteria to ensure that people do not contaminate the salt chamber with germs. Even in some, every three to four months, they grind off a few millimeters of the wall because of the bacilli. When their use was abandoned, it was quiet for about five years, and it started again. If it's not kept clean, it can be detrimental to health; some types of pneumococcus also stick in there. In our case, they tried to mitigate this by putting in air conditioning systems. But an artificial salt cave system that is fully air-conditioned cannot work. That's about like trying to replicate the Tatra air in a seventh-floor apartment block, it's stupid.

� Prof. MUDr. Svetoz�r DLUHOLUCK�, CSc�� (back to content)

1.2.10.1 Dark Ages ^f

The fall of the Roman Empire marked the beginning of the Dark Ages in Europe. The later stages of the Roman Empire were a period of epidemic disease and population decline. The population of cities in particular was to fall and the cities paved roads, drains, aqueducts and public baths soon fell into disrepair. The decline of the cities was accompanied by a decline in classical learning which was opposed by the new Christian church. In 391 CE a Christian mob set fire to the great library of Alexandria and murdered the pagan philosopher Hypathia. The last pagan school of learning, the academy in Athens was closed in 529 CE by order of the Emperor Justinian.

Medicine was not to escape the general decline of learning which accompanied the fall of the Roman Empire and the arrival of Christianity. There was a return to the belief that the cause of much illness was supernatural. Illness was a punishment from God for people�s sins. The curing of such disease by medical practices was contrary to Gods will. The only appropriate treatment was prayer and penitence. Diseases might also be caused by witchcraft, possession by demons or spells made by elves and pixies. Some of the old learning did survive, ironically in Christian monasteries where monks copied and translated classical writings. Their work mixed superstition and religion with classical learning and knowledge. Bede, (born 673 CE) an English monk famous for his Ecclesiastical History of the English People and one of the most learned men of the Dark Ages, also wrote on medical matters. He referred to Hippocrates and the theory of the four humors and prescribed bleeding as the appropriate treatment for hot fevers caused, as he believed by an excess of blood. But he also considered magic incantations and the wearing of magic amulets as the way to deal with spells made by pixies. There are also stories of miraculous cures such as a leper sleeping where a saint died and being cured when waking the next morning.

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Not much had changed by the 12th century CE when Hildegard of Bingen began to bring together classical medical beliefs with 12th century religious beliefs. She considered the imbalance of the four humors resulted from mans ejection from the Garden of Eden. The eating of the forbidden fruit destroyed the balance of the four humors in the human body. Sin was to cause the imbalance of the humors and was therefore the cause of disease. Some of her medical beliefs could not be regarded as scientific or rational. Her cure for jaundice was to tie a live bat, first to the patient�s back and then to the patient�s stomach. Failing eyesight, caused by excessive lust, was to be cured by placing the skin of a fish�s bladder over the patients eyes when he goes to sleep, but it had to be taken off by midnight.

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1.2.10.2 Arab medicine ^w

The Moslem prophet Mohammed was born in 570 CE and he and his successors were to conquer an empire extending from Spain to India. The early Moslems had a tolerant attitude to Christian and Jewish minorities who were allowed to freely practice their religions. The origins of Arabian medicine lay with a heretical Christian sect known as the Nestorians. The Nestorians under threat of persecution from orthodox Christians fled eastwards toward present day Iraq and Iran. They brought with them classical texts from a range of authors including Hippocrates, Aristotle and Galen which they proceeded to translate into Arabic. At this time the Arab world had a positive attitude to new ideas and was happy to adopt the ideas of classical scholars like Aristotle and Galen.

The first great Arab medical authority was Rhazes who was born in 854 CE. Rhazes believed illness had nothing to do with evil spirits or God and that classical authorities were not above criticism. He was in frequent disagreement with Galen. He considered Galen�s cure for asthma consisting of a mixture of owl�s blood and wine did not work as he had tried it and found it to be useless. He questioned the belief that disease could be diagnosed by studying the patient�s urine and was the first medical authority to understand the difference between measles and smallpox. Rhazes gave a full description of diseases he encountered giving his diagnosis, prognosis and treatment. His understanding of the workings of the human body were however, hindered by the Islamic prohibition on dissections of the human body. Arabian medicine�s second great authority was Avicenna (980-1037) whose book the Cannon of Medicine was to become the leading medical work in both Europe and the Middle East for some 600 years. Avicenna�s Cannon includes many of the ideas of Hippocrates, Aristotle and Galen but also includes many of Avicenna�s own ideas. The Cannon deals with a range of diseases and describes their diagnosis, prognosis and treatment.� Avicenna accepted Hippocrates and Galen�s theory of the four humors. Treatments included bleeding, enemas and purges while diagnosis included examining the pulse and urine. Over 700 drugs were recognized by Avicenna and the Cannon provided instructions on how they were to be prepared, which drugs should be used for which illness and their effects. Wounds were dealt with by cauterizing, a treatment that dates back to Ancient Egypt.

Surgery in the Arab world was not respected and surgeons were usually craftsmen. One exception to this is Albucasis (936-1013) who practiced in Cordoba in southern Spain. Albucasis wrote a book called Tasrif or the Collection which provided full accounts of surgery practiced at the time. The Collection was to become the standard book on surgery during medieval times. The book prescribes a range of surgical procedures including trepanning, dentistry, mastectomy and lithotomy and advocates cauterization as a treatment for a wide range of problems.

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1.2.10.2.1 Unani medicine ^w

Unani or Yunani medicine (Urdu: طب یونانی tibb yūnānī) is Perso-Arabic traditional medicine as practiced in Muslim culture in South Asia and modern day Central Asia. Unani medicine is pseudoscientific. The Indian Medical Association describes Unani practitioners who claim to practice medicine as quacks.

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Birbahuti (Trombidium red velvet mite) is used as Unani Medicine

The term Yūnānī means "Greek", as the Perso-Arabic system of medicine was based on the teachings of the Greek physicians Hippocrates and Galen.

The Hellenistic origin of Unani medicine is still visible in its being based on the classical four humours: phlegm (balgham), blood (dam), yellow bile (ṣafrā) and black bile (saudā'), but it has also been influenced by Indian and Chinese traditional systems.

History

Arab and Persian elaborations upon the Greek system of medicine by figures like Ibn Sina and al- Razi influenced the early development of Unani.

Unani medicine interacted with Indian Buddhist medicine at the time of Alaxander's invasion of India. There was a great exchange of knowledge at that time which is visible from the similarity of the basic conceptual frames of the two systems. The medical tradition of medieval Islam was introduced to India by the 12th century with the establishment of the Delhi Sultanate and it took its own course of development during the Mughal Empire, influenced by Indian medical teachings of Sushruta and Charaka. Alauddin Khalji (d. 1316) had several eminent physicians (Hakims) at his royal courts. This royal patronage led to the development of Unani in India, and also the creation of Unani literature.

Education and recognition

There are several Indian universities devoted to Unani medicine, in addition to universities that teach traditional Indian medical practices in general. Undergraduate degrees awarded for completing an Unani program include the Bachelor of Unani Medicine and Surgery, Bachelor of Unani Tib and Surgery, and Bachelor of Unani Medicine with Modern Medicine and Surgery degrees. A small number of universities offer post-graduate degrees in Unani medicine.

The Central Council of Indian Medicine (CCIM), a statutory body established in 1971 under the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy (AYUSH), monitors higher education in areas of Indian medicine including Ayurveda, Unani, and other traditional medical systems. Another subdivision of AYUSH, the Central Council for Research in Unani Medicine (CCRUM), aids and co-ordinates scientific research in the Unani system of medicine through a network of 22 nationwide research institutes and units.

To fight biopiracy and unethical patents, the Government of India set up the Traditional Knowledge Digital Library in 2001 as repository of formulations used in Indian traditional medicine, including 98,700 Unani formulations.

In 1990, the total number of hakims or tabibs (practitioners of Unani medecine) in Pakistan was 51,883. The government of Pakistan's National Council for Tibb (NCT) is responsible for developing the curriculum of Unani courses and registering practitioners of the medicine.

Various private foundations devote themselves to the research and production of Unani medicines, including the Hamdard Foundation, which also runs an Unani research institution

The Qarshi Foundation runs a similar institution, Qarshi University. The programs are accredited by Higher Education Commission, Pakistan Medical and Dental Council, and the Pakistan Pharmacy Council.

Critism and safety issues

Some medicines traditionally used by Unani practitioners are known to be poisonous.

The Indian Journal of Pharmacology notes:

According to WHO, "Pharmacovigilance activities are done to monitor detection, assessment, understanding and prevention of any obnoxious adverse reactions to drugs at therapeutic concentration that is used or is intended to be used to modify or explore physiological system or pathological states for the benefit of recipient."

These drugs may be any substance or product including herbs, minerals, etc. for animals and human beings and can even be that prescribed by practitioners of Unani or Ayurvedic system of medicine. In recent days, awareness has been created related to safety and adverse drug reaction monitoring of herbal drugs including Unani drugs.

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1.2.10.3.1 Medieval European medicine ^w

European medicine began to move away from the supernatural explanations of disease with the founding of a medical school at Salerno. The school was probably founded in the ninth century and reached its greatest heights between the tenth and thirteenth centuries. Anatomy was taught at Salerno based on the dissection of pigs whose internal organs were thought to be similar to those of humans. Passionarius, a book written by Gariopontus, one of the teachers at the school, was based upon classical Greek learning while the arrival in Salerno of Constantine the African around 1075 with many Arab medical works was to greatly improve the medical knowledge at Salerno and eventually all Europe. Constantine was to spend the remainder of his life translating the Arabic texts into Latin and so bring the classical Greek authors, upon whose work Arabic medicine was based, to Europe.

The translation of Arabic medical texts into Latin continued in early medieval times so that the works of Hippocrates, Aristotle, Galen, Rhazes, Avicenna and Albucasis became well known. They soon assumed a status of great authority and their initial impact was to help free medicine from supernatural and magical explanations and cures. Their status however was eventually to hold back the improvement of European medicine as new ideas contrary to those of the Greek and Arab writers had great difficulty in obtaining acceptance.

New medical schools at Montpellier, Bologna, Paris and Padua were founded that significantly increased medical knowledge.� The knowledge of anatomy improved with the occasional human dissection being performed as post-mortem examinations for judicial purposes and with occasional dissections of the bodies of executed criminals. Anatomy was also improved by Mondino de Luzzi or Mundinus who taught at Bologna. His book Anothomia brought a new level of knowledge of anatomy, although he did repeat many of the errors of Galen. Mundinus however did most of his dissections himself, unlike other teachers who sat on a high chair somewhat above the body reading a book supposedly describing the dissection, but probably only loosely related to it. Guy de Chaulias, the leading surgeon of the 14th century was a pupil of Mundinus.

The most dramatic medical event of the 14th century in Europe was the arrival of the Black Death. It originated in China killing up to two thirds of the population and then spread along trade routes to Europe and the Arab world. It killed half the population of Cairo and between a quarter and a third of the population of Europe. The medical authorities in Europe had no solution to the Black Death. The idea of a contagious disease was beyond the understanding of medical knowledge in either the Arab or European world during the 14th century. The Arabs considered the Black Death was caused by evil spirits; the Europeans blamed everything from the Jews to Gods punishment for human�s sins. Jews were accused of poisoning wells and entire Jewish communities were wiped out by vengeful Christians. Flagellants travelled around Europe whipping themselves for their sins hoping this would appease God. Conventional medicine of the time had no answers; bleeding, cauterizing and cleaning the air with incense were all tried and failed. Quarantining worked to some extent but the best advice was to run like the wind. The failure of conventional medicine during the Black Death led to a revival of supernatural explanations of disease.

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1.2.10.3.2 Traditional Mongolian medicine ^w

Traditional Mongolian medicine developed over many years among the Mongolian people. Mongolian medical practice spread across their empire and became an ingrained part of many other people's medical systems.

History

The Mongols were part of a wider network of Eurasian people who had developed a medical system of their own, including the Chinese, Korean, Tibetan, Indian, Uighur, Islamic, and Nestorian Christians. They took the medical knowledge of these people, adapted it to develop their own medical system and at the same time organized an exchange of knowledge between the different people in their empire. On their journeys throughout Asia, the Mongols brought with them a team of doctors. Usually foreign, these doctors themselves had brought medical knowledge from other people in Asia to the Mongol court. They serve three purposes on the journeys on which the accompanied Mongol princes. Their first purpose was to be the personal physicians of the princes in case they required medical attention. The second was to observe and obtain any new medical knowledge from the various groups of people that they encounter.

Finally, they were to also spread the medical knowledge that the Mongols had put together to the peoples they encountered. The Mongols were also able to contribute new or more advanced knowledge on topics such as bone setting and treatments of war wounds because of their nomadic lifestyle. The Mongols were the first people to establish a link between diet and health.

Traditional Mongolian doctors were known as shaman, or holy men. They relied on magic and spiritual powers to cure illness. They were called on to determine whether the illness was caused by natural means or because of malicious wishes. Though they were often used as healers, their main strength was in prophecy readings. Foreign physicians who used herbs to treat illness were distinguished from the shamans by their name, otochi, which meant herb user or physician. It was borrowed from the Uighur word for physician, which was otachi. When Mongolian medicine began to transition to using herbs and other drugs and had the service of foreign doctors, the importance of shamans as medical healers began to decline.

Hu Sihui (1314�1330) was a Mongol court therapist and dietitian during Mongol Yuan Dynasty reign in China. He is known for his book Yinshan Zhengyao (Important Principles of Food and Drink), that became a classic in Chinese medicine and Chinese cuisine. He was the first to empirically discover and clearly describe deficiency diseases.

Treatment practices

Animal blood

Animal blood was used to treat a variety of illness, from gout to blood loss. Recorded in the Yuan Shih, are many incidents where the blood of a freshly killed animal, usually a cow or an ox, was used to treat illness. Gout, which was a common affliction of the Mongol people, was treated by immersing the afflicted body part into the belly of a freshly killed cow. Placing a person in the stomach of an animal was also used as a method of blood transfusion. On the battlefield, when a soldier became unconscious due to massive amount of blood loss, he would be stripped and placed into the stomach of a freshly killed animal until he became conscious again. In less severe cases, the skin of a freshly killed ox was combined with the masticated grass found in a cow's stomach to form a sort of bandage and ointment to heal battle wounds. It was believed that the stomach and fat of the freshly killed animal could absorb the bad blood and restore the wounded to health.

Minerals

Mongolian medical literature mentions the use of minerals in medicine, usually in the form of powdered metals or stones. From the Chinese, Mongolians also used cinnabar or mercury sulfide as treatment options, despite the high number of casualties it caused. Both the Chinese and the Mongols believed that cinnabar and mercury sulfide were the elixir of life.

Herbs

Herbs were the mainstay of Mongolian medicine; legend had it that any plant could be used as a medicine. An emchi is quoted as saying:

All those flowers, on which butterflies sit, are ready medicine for various diseases. One can eat such flowers without any hesitation. A flower rejected by the butterflies is poisonous, but it can become medicine, when it is properly composed.

Acupuncture and moxibustion

The Mongolian adopted the practice of acupuncture from the Chinese. They adapted this tradition and made it a Mongolian form of treatment when they burned herbs over the various meridian points rather than used a needle. The tradition of Moxibustion (burning mugwort over acupuncture points) was developed in Mongolia and later incorporated into Tibetan medicine.

Water

One unusual aspect of Mongolian medicine is the use of water as a medicine. Water was collected from any source, including the sea, and stored for many years until ready for use. Acidity and other stomach upsets were said to be amenable to water treatments.

Bone setting

Bone setting is a branch of Mongolian medicine carried out by Bariachis, specialist bone setters.

They work without medicines, as anesthetics or instruments. Instead they rely on physiotherapy to manipulate bones back to their proper position. This was done without any pain to the patient.

Bariachis are laypeople, without medical training, and are born into the job, following the family tradition. They had the ability to fix any bone problem, no matter how severe or difficult. When

Chinese physicians were brought into the Mongolian empire, Wei Yilin, a famous Yuan orthopedic surgeon established particular methods for setting fractures and treating shoulder, hip, and knee dislocations. He also pioneered the suspension method for joint reduction. He was not only an orthopedic surgeon but also an anesthesiologist who used various folk medicine for anesthetics during his operations. It appears that this traditional practice is in decline, and that no scientific research has been carried out into it.

Pulse diagnosis

Pulse diagnosis is very popular in Western Asia and especially Iran, and its introduction to the Islamic West can be traced back to the Mongols. The Mongol word for pulse, mai, has Chinese etymology. In China, pulse diagnosis was related to the balance between the yin and yang.

Irregular pulses were believed to be caused by an imbalance of the yin and the yang. However, when the Mongol adopted this medical practice, they believed that the pulse was directly related to moral order and that when the moral order was chaotic, so the pulse would be chaotic and irregular as well. This belief is highlighted in a story recounted in the Yuan Shih. In 1214, Ogodei Qa'an had an irregular pulse, and was very ill. His most trusted physician ordered that a general amnesty be declared all across the empire. Shortly afterwards, Ogodei Qa'an was restored to health and his pulse regular once again. For the Mongol, this account gives evidence to the direct relationship between pulse and moral order. Pulse diagnosis soon became the primary diagnosis' tool and became the cornerstone of Mongolian medicine. Qubilai decreed that Chinese manuals on pulse-based medicine be translated to Mongolian. His successor, Tem�r, in 1305, ordered that pulse diagnosis be one of the ten compulsory subjects in which Imperial Academy of Medicine medical students be tested. In pulse diagnosis, there was a distinction between measuring a child's pulse versus and adult's pulse, and this distinction was greatly emphasized in the Chinese texts that were translated, and later in the Mongolian texts.

Discovery of the link between diet and health

In 1330, Hu Sihui, a Mongolian physician published Yinshan Zhengyo (Important Principles of Food and Drink). It was the first book of its kind. In this textbook, Hu Sihui preached the importance of a balanced diet with a focus on moderation, especially in drinking. He also listed beneficial properties of various common foods, including fish, shellfish, meat, fruit, vegetables, and 230 cereals. Grapes were recommended for character strengthening and boosting one's energy levels. However, eating too many apples could cause distension and indulging in too many oranges lead to liver damage. A common menu item, dog meat, was very beneficial because it calmed the liver, spleen, heart, lungs, kidneys, and pericardium. This link between diet and health was spread far and wide by the Mongols on their journeys across the Eurasian steppe lands.

Dom

Dom is the tradition of household cures, many based simply on superstition � one instance being that a picture of a fox hung over a child's bed will help it sleep. Counting the frequency of breathing is also stated to be a relief for psychological problems and distress.

The practise apparently was part of lamaist popular medicine.

Eating papers

Strip of Mongolian eating papers with Tibetan (left) and Mongolian (right) text Traditional Mongolian medicine today

A printing stock found in eastern Mongolia in the 1920s documents a historical custom of eating a piece of paper with words printed on it, in order to prevent or heal maladies. On fields of about 24x29 mm magical incantations in Tibetan are printed, along with use instructions in Mongolian.

Traditional Mongolain Medicine Today

Today Mongolia is one of the few countries which officially supports its traditional system of medicine.

Since 1949, the Chinese government has steadily promoted advances in Mongolian medical care, research and education. In 1958 the Department of Traditional Chinese and Mongolian Medicine at the Inner Mongolia Medical College opened its doors to students. In 2007 it expanded, opening a state of the art campus just outside Hohhot City. The Chinese government has also established scores of Mongolian medicine hospitals since 1999, including 41 in Inner Mongolia, 3 in Xinjiang, and 1 each in Liaoning, Heilongjiang, Gansu and Qinghai.

Coding (therapy)

Coding (also known as the Dovzhenko method) is a catch-all term for various Russian and post-Soviet alternative therapeutic methods used to treat addictions, in which the therapist attempts to scare patients into abstinence from a substance they are addicted to by convincing them that they will be harmed or killed if they use it again. Each method involves the therapist pretending to insert a "code" into patients' brains that will ostensibly provoke a strong adverse reaction should it come into contact with the addictive substance. The methods use a combination of theatrics, hypnosis, placebos, and drugs with temporary adverse effects to instill the erroneous beliefs. Therapists may pretend to "code" patients for a fixed length of time, such as five years.

Coding was created by Aleksandr Dovzhenko, a Soviet psychiatrist.

In the case of alcohol addiction, the procedure may be carried out with a drug that temporarily affects the respiratory system when mixed with alcohol, administered under hypnosis. The therapist gives patients the drug, then allows them a small amount of alcohol, which triggers an adverse reaction and makes them erroneously believe that the therapy has had a long-term effect. Another method involves the therapist giving patients hypnotic suggestions during a head massage, with the message that alcohol will cause blindness or paralysis.

In one method, the therapist numbs patients' mouths with local anaesthetic, then places electrodes with a very weak current into their mouths. This is to make patients believe that the "nerve points" in their mouth are being "manipulated" and that it is no longer safe for them to drink alcohol. A further method involves the therapist using a special helmet to persuade patients that the therapist's suggestions are controlling their minds. Typically, therapists will also make patients sign a disclaimer, supposedly absolving the therapist of any responsibility should the patient use the addictive substance and suffer ill effects or die.

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1.3.0 The Renaissance ^w

A revolution was to take place in medicine at the time of the Renaissance. It was to involve the breaking of the stranglehold classical and Arabic thought, especially Galen and Avicenna, had on medicine and its replacement by a belief in observation and experiment. One of the principal proponents of the new beliefs was Paracelsus who attacked academic learning, especially Galen and Avicenna and advocated learning from experience. His own ideas however were not much of an improvement on the classical learning. He rejected the humoral theory, but considered everything was made out of sulphur, mercury and salt. Sulphur caused inflammability, mercury volatility and salt solidity in substances. He also believed in the �doctrine of signatures� the idea that assumed plants capable of healing visibly showed their healing qualities. Heart shaped lilac leaves would cure heart disease and yellow celandine would cure jaundice.

However, Paracelsus�s interest in alchemy led him to some significant discoveries. He noticed the anaesthetic effects of ether and tincture of morphine which he called laudanum. He recognised that particular substances had their own individual qualities and that compounds including those substances often had some of those same qualities. He considered that each disease needed to be cured by its own remedy. The main value of Paracelsus�s ideas, were in his iconoclastic attack on classical medical learning, which was held in vastly excessive reverence in Paracelsus�s time. After Paracelsus it became easier to criticise established medical learning and for new ideas to be accepted.

A contemporary of Paracelsus, Fracastorius, suggested contagious disease was caused by tiny seeds invading the human body. The seeds were too small to be seen with the human eye and could find their way into the body from the air, from bodily contact or from infected clothes or bed linen. Once they had entered the human body they could multiply causing people to fall ill. Fracastorius also considered each disease was caused by its own particular seed leading Fracastorius to clearly distinguish between such contagious diseases as smallpox, measles, the plague, syphilis and typhus. Previously contagious diseases were sometimes considered to be versions of the same disease with varying degrees of intensity. Fracastorius�s theory is virtually identical to the germ theory of disease but in the 16th century, without microscopes, he was unable to prove the theory. Physicians preferred other theories, such as the humoral theory, which while also unprovable at least had the support of tradition and ancient authority.

The study of anatomy was to undergo a revolution at the hands of Vesalius. Vesalius was able to dissect human corpses and this enabled him to provide a generally accurate picture of the human body. Previously anatomy had suffered from the prohibition on human dissection that extended back to classical times, so that knowledge of human anatomy was based on animal dissections. Before Vesalius the accepted authority was Galen whose anatomical studies were based on animal dissection and whose work had acquired such a status that to question it could involve accusations of heresy.

Vesalius was able to obtain human corpses for dissection; as public authorities were prepared to allow the dissection of the corpses of executed criminals. Some physicians had previously dissected the corpses of criminals, but such was the reputation of Galen that they had not noticed or not dared to point out that the dissection of humans showed that much of what Galen had said was wrong. Versalius�s strength was that he was prepared to rely on his observations and where these contradicted Galen he was prepared to say Galen was wrong. Vesalius�s great work was the De Humani Corporis Fabrica usually called the Fabrica.� It consisted of seven books, the first dealing with the skeleton, the second with the muscular system, the third with the veins and arteries, the forth with the nervous system, the fifth with the abdominal organs, the sixth with the heart and lungs and the seventh with the brain. The Fabrica especially books 1 and 2 were illustrated with high quality drawings showing the various human parts in considerable detail. In book 1 Vesalius emphasizes that the bones supported the human body, played an important role in movement and provided protection for other parts of the body. The illustrations in book 2 show the muscles in the order in which a person dissecting a body would see them. The upper layer of muscles, are shown then the layer below them and then the next layer and so on. Book 3 gives a good description of the arteries and veins and book 7 describes some of the structure of the brain for the first time.

The book corrected certain of Galen�s errors. It questioned Galen�s suggestion that blood flowed from the right ventricle of the heart to the left ventricle. Vesalius also showed that the rete mirabile did not exist, that the liver was not divided into five lobes, that the uterus had multiple chambers and that the pituitary was directly connected to the nose. Vesalius�s expose of such errors by Galen resulted in some criticism of Vesalius�s work from physicians who considered any questioning of Galen to be outrageous.

Vesalius did make some errors. His descriptions of the visceral organs (the liver, the kidney and the uterus) were based upon those of pigs and dogs. He failed to notice the pancreas, the ovaries and the adrenal glands. His description of female organs was poor, probably due to there being fewer female bodies available for dissection. Nevertheless, the book still represented an enormous advance in human knowledge of anatomy.

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1.3.1 CIRCULATION OF THE BLOOD

Classical physicians were aware of the existence of the heart, but had little idea of its function in the human body. They realized when the heart stopped beating life would stop which led them to believe the heart had a significant role during and at the end of life. They considered the heart was where the soul was located when a person was living and the soul left the body when a person died.

Classical physicians had little understanding of the relationship between the heart and the blood. They did not know how blood got to the heart, how it got from the right ventricle to the left ventricle or what happened after it left the heart. They believed the heart provided a �vital spirit� to blood passing through the heart. They also believed the arteries did not contain blood as when a person or animal dies, the heart stops pumping blood into the arteries, which then contract and drive their blood into the veins. This only leaves air in the arteries of a dead person or animal and classical physicians only dissected dead bodies and so never discovered blood in the arteries. The veins in dead bodies are full of blood, especially the veins connected to the liver. This led classical physicians to believe that the liver created blood which was passed through the veins to the rest of the body. It was also believed that the body somehow absorbed the blood.

Galen, who had the opportunity to observe the internal organs of living human beings while acting as physician to injured gladiators had a better understanding of the heart and blood. He understood the arteries contained blood in living people and that the heart was a pump which pushed blood from the right ventricle of the heart into the lungs which then flowed into the left ventricle and from there into the arteries. This circulation from the right ventricle to the lungs and then to the left ventricle was known as the pulmonary transit. Galen however still believed that the liver created the blood, but also that it pumped the blood to the rest of the body and that blood was passed directly form the right ventricle to the left ventricle of the heart. The irony is that Galen�s work on the pulmonary transit, which was at least partly right, was largely not noticed, while other work which was quite erroneous like the humoral theory was treated as holy writ.

The idea of the pulmonary transit was revived by the Arab physician Ibn al-Natis in the 13th century when he suggested that all the blood went from the right ventricle to the lungs and then to the left ventricle and none travelled directly from the right ventricle to the left ventricle. In the 16th century the same idea was suggested by Michael Servetus and accepted by Realdo Colombo. Colombo also suggested the heart could act as a pump and discovered the presence of valves in the veins which ensured that the blood could move only in a single direction from the right ventricle to the lungs and then to the left ventricle.

The classical ideas concerning the heart and blood were beginning to be challenged in the 16th century. Ideas of the pulmonary transit, the heart acting as a pump and valves in the veins ensuring blood flowed only one way questioned the classical orthodoxy still largely accepted in Renaissance Europe. Into this environment William Harvey proposed his ideas of the continuous circulation of the blood.

Harvey had been carrying out dissections on a wide range of living animals and it is from his observations of their living organs that he was able to understand how the blood circulates through the human body. His book De Motu Cordis begins by explaining the structure of the heart and what it does. The heart consists of two upper parts called the auricles and two lower parts called the ventricles. The left auricle and the left ventricle were separated from the right auricle and the right ventricle by an impenetrable muscular wall. The question of whether the auricles or the ventricles beat first was difficult to resolve as hearts would often beat too fast for normal observation to provide an answer. Harvey answered the question by observing the hearts of cold blooded animals like fish which beat slowly and then confirmed it by observing the slow beating hearts of dying warm blooded animals. He observed the auricles beat first, pushing blood into the ventricle which contracted pushing blood out of the heart.

The classical theory considered blood was made by the liver, flowed through the heart and was absorbed by the body. Harvey calculated the amount of blood that flowed through the heart of a dog. He calculated the number of heart beats per minute, which was the number of times the heart pumped blood out into the body. He also calculated the quantity of blood that was pumped with each heart beat and concluded that the heart pumped blood weighing three times the weight of the whole body each hour. The question arose as to where all this blood came from, and where did it all go. Blood equivalent to three times a person�s body weight per hour could not come from food and drink consumed. No one could eat or drink that much per hour. Nor could that quantity of blood be absorbed by the body every hour. Veins, arteries and tissues would explode with that quantity of blood being poured into them every hour. Harvey suggested the solution to this problem was that blood was not being created by the liver or absorbed by the body, but that the same blood was constantly circulating around the body.

Galen had suggested that the blood moved in both directions in the veins and arteries. Harvey showed that valves in the veins ensured that blood moved in only one direction. He showed that blood in the veins always moved towards the heart, by pressing a vein, blood accumulated in the vein on the side of the compression away from the heart. The side of the compression close to the heart would be emptied of blood as the blood flowed to the heart and away from the compression point. When an artery was pressed the blood built up on the side of the compression closest to the heart. This indicated the blood flowed in a single direction, in the veins towards the heart, and in the arteries away from the heart.

The consequences of the blood all flowing in one direction and the same blood constantly be circulated, without blood being created by the liver or absorbed by the body was a revolution in physiology. New ideas often receive considerable criticism and Harvey�s idea of constantly circulating blood was attacked for daring to disagree with Galen. One rational criticism of Harvey�s theory was that Harvey could not show how blood flowing out of the heart to the arteries could connect to the veins and flow back into the heart. Harvey suggested tiny connections, too small to be seen with the naked eye, linked the arteries and the veins but he could not prove their existence. This problem was solved by Marcello Malpighi, in 1661, when using a microscope he was able to observe the existence of capillaries linking the arteries and the veins which allowed blood to flow from the arteries to the veins so that the idea of the circulation of the blood was complete.

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1.3.2 JENNER AND VACCINATION

Smallpox goes back at least to Ancient Egypt and was in Greece in the classical period and was present in Ancient China and India. The symptoms of the disease were described by Al-Razi in 910 CE and involved blisters filled with puss appearing on the eyes, face, arms and legs. Twenty to forty percent of those who caught smallpox died from it and the survivors were covered with disfiguring scars. In London in the 17th and 18th centuries a third of the people had smallpox scars and the majority of cases of blindness were caused by smallpox.

It had been observed that people who survived smallpox did not usually catch it again. The idea developed that if a mild case of smallpox could be produced it would protect a person from future smallpox attacks. In the East dust from a smallpox scab was blown into the nose to induce a mild case of smallpox to create immunity from future attacks. In Ottoman Turkey smallpox material was rubbed into small cuts made in a person�s arm. These methods of conferring immunity from smallpox were made known in England in the early 18th century but were ignored.

The practice of deliberately giving a person a mild case of smallpox began in England in the early18th century with Lady Mary Montagu. The practice became known as variolation and Lady Montagu who had learnt about the practice in Turkey had her own daughter variolated in the presence of newspaper reporters which ensured substantial publicity. Lady Montagu then persuaded the Prince and Princess of Wales to have their children variolated which ensured even more publicity. Variolation also took place in America where Zabdiel Boylston, a Boston physician, heard of variolation from an African slave and faced with a smallpox epidemic variolated 244 people of whom only 6 died. Surgeons however demanded patients go through a 6 week period of bleeding, purging and dieting before variolation which limited the popularity of the practice and resulted in patients being weakened before variolation took place. Variolation turned out to be quite dangerous with modern estimates that 12% of patients died; a lower death rate than the 20-40% who might die in a smallpox epidemic, but certainly not a perfect treatment for the problem of smallpox.

A better treatment was to come with Edward Jenner, who while training as a surgeon in 1768, heard that milkmaids who had contacted cowpox were immune from smallpox. Cowpox resulted in lesions on the milkmaids hands, but had no other symptoms. Later Jenner met a Mr Frewster who in 1765 had presented a paper to the London medical society on the ability of cowpox to prevent future smallpox attacks. The paper was never published but reminded Jenner of what he had heard of cowpox from the milkmaids. Cowpox is part of a family of animal poxes, including horsepox, cowpox, swinepox and smallpox all caused by the orthopox virus. All the animal pox diseases can infect humans and an infection from anyone of them will protect people from all the other animal poxes. In December 1789 Jenner began a series of experiments. He inoculated three people including his son with swinepox and later variolated them with smallpox and none of them produced the rash that usually came from variolation with smallpox. Swinepox seemed to protect them from smallpox. Later in 1796 Jenner put cowpox into a healthy 8 year old boy and after he developed normal cowpox symptoms variolated him with smallpox. The boy did not develop any of the symptoms that normally occurred with variolation with smallpox. Jenner then took fluid from the boy�s cowpox pustle and used it to inoculate some more children and fluid from their cowpox pustles was used to inoculate some more children. Two of these were later variolated with smallpox, but did not develop any of the symptoms that normally occurred with variolation, confirming the initial experiment. The experiment showed that cowpox could provide protection against smallpox without any of the risks of variolation. The practice of cowpox inoculations, which began to be called vaccination, was soon done throughout the British Empire, the United States and Europe although there was some opposition to it. The opposition gradually disappeared and eventually late in the twentieth century smallpox was completely eliminated.

1.3.3 THE DISCOVERY OF ANAESTHESIA

A vital component of modern surgical operations is the use of anaesthesia. Without anaesthesia operations would be excruciatingly painful and as a result many patients chose not to have operations. The pain of having limbs amputated could result in patients dying of shock and forced surgeons to perform operations with extreme speed. The best surgeons could amputate a limb in less than a minute. The state of mind of a person awaiting surgery would be similar to that of a person about to be tortured or executed. When London hospital was built in 1791, and was to act as a model for other hospitals, the design took into account the lack of effective anaesthetics. The operating room was on the top floor, partly to allow sunlight through a skylight to illuminate the operation, but also so the patient�s screams would not travel through the hospital and could be muffled by extra heavy doors. When an operation was to commence hospital staff would go to the top floor and assist in holding the patient down and if necessary in gagging the patient.

The problem with an effective aesthetic that will allow major surgery is that it must place the patient in a state where the central nervous system is depressed to an extent where painful stimuli cause no muscular or other reflexes. This is far beyond ordinary sleep as obviously performing surgery on a sleeping person will wake them. Effective surgical anaesthesia must place the patient in a state close to that of death. In the past various attempts were made to reduce or eliminate pain during surgical procedures. Dioscorides, a Greek physician in the early Roman Empire, used drugs such as henbane and mandrake root to relieve pain. These drugs continued to be used into medieval times. Arab physicians seemed to have used drugs such as opium and hyoscyamus. Alcohol was often used but was probably more effective at making the patient easier to hold down than in relieving pain.� Soporific sponges, involving the inhalation of drugs such as opium, mandragora and hyoscyamus were used from around the ninth century. However modern experiments with such sponges suggest they had no aesthetic effect at all. The use of soporific sponges was discontinued in the seventeenth century. It may well be due to the lack of effectiveness of pre-modern anaesthetics that their use was not widespread. Egyptian papyri and the Code of Hammurabi describe surgery without mention of anaesthetics. Only one Chinese surgeon, one Indian surgeon and a few Greek, Roman and Arab surgeons seem to have made any attempt to relieve pain during surgery. Pre-modern attempts to relieve pain during surgical operations seem to have been of little or no effect.

The first step in the development of modern anaesthetics was the discovery of ether. In 1275, the Spanish alchemist Raymundus Lullius produced ether by mixing alcohol with sulfuric acid. Paracelsus used ether to relieve pain in 1605 in some of his medical patients but not in surgery as he was not a surgeon.

Nitrous oxide, soon to be known as laughing gas, was discovered by Joseph Priestly in 1772. Priestley however did not realize nitrous oxide could act as an anaesthetic. Others however soon discovered both nitrous oxide and ether had an intoxicating effect when inhaled and soon �ether frolics� and �laughing gas parties� became a popular source of amusement. It was soon observed that minor injuries such as bruises received at the frolics and parties were not accompanied by any pain. In addition, Humphrey Davy discovered that nitrous oxide relieved the pain of an inflamed gum and jaw and suggested nitrous oxide could be used in surgery. Similar observations concerning nitrous oxide were made by William Barton in the United States. In 1842 ether was used to painlessly extract a tooth, by a dentist, Dr.� Elija Pope, acting on the suggestion of William Clark a chemistry student who had participated in ether frolics.

The first use of ether for surgical purposes was by Crawford Long in Georgia, USA in 1842. Long had attended ether frolics and had noticed bruises he had received while under the influence of ether had involved no pain. Realizing that ether had stopped the pain he used it in various surgical operations and in obstetrical procedures. He did not however publish his work until 1849.

A dentist, Horace Wells, while attending a nitrous oxide party in 1844 noticed a person injuring his legs without suffering any pain. Realizing nitrous oxide could serve as a dental anaesthetic Wells had one of his own decaying teeth removed by another dentist while he was under the influence of nitrous oxide. Wells experienced no pain and was soon performing dentistry using nitrous oxide on his own patients. However, when he attempted a public demonstration at Massachusetts General Hospital he used insufficient gas and the demonstration was not a success.

The public demonstration at Massachusetts General Hospital had been arranged by Wells former dentistry partner William Morton. Morton, who had possibly seen Long operate in Georgia, became interested in ether as an anaesthetic and had discussed it with Charles Jackson, a doctor in Harvard�s medical faculty and at Massachusetts General Hospital. Intending to patent the anaesthetic Morton and Jackson disguised the ether by mixing it with aromatic oils and called it Letheon. They then arranged public demonstrations of the use of Letheon, in 1846, for pulling teeth and for an operation removing a tumour from a patient�s jaw. Both the dentistry and the operation were carried out painlessly. Jackson and Morton however were forced to withdraw the patent for Letheon and reveal that Letheon was really ether by pressure from the surgeons involved in the operations. By the end of 1846 news of the use of ether as an anaesthetic had travelled across the Atlantic and in December 1846 it was used in an operation in London.

Jackson, Morton and Wells all claimed to be the discoverer of surgical anaesthesia and in 1847 the United States Congress became involved in trying to sort out who was the true discoverer of anaesthesia. Congress eventually dismissed Wells and Morton�s claims and decided it was between Jackson and Long. The American Medical Association, in 1872, gave the credit to Wells, while in 1913 the electors of the New York University Hall of Fame named Morton as the discoverer of surgical anaesthesia. The American College of Surgeons, in 1921, decided Long should be credited with the discovery.

Attempts were soon made to use ether in obstetrics but it was found to be unsuitable. Ether often produced vomiting patients, irritated lungs and a bad smell. Chloroform had been discovered independently in 1831 by Samuel Gutherie in New York, by Eugene Soubeiran in Paris and by Liebig. Initially its anaesthetic quality was not recognised but Gutherie�s daughter had become unconscious for several hours after tasting it. In 1847 Sir James Simpson while looking for an anaesthetic to use in obstetrics tried chloroform on himself and having found it to be an effective anaesthetic began using it in surgical operations. Its use was soon extended to obstetrics provoking considerable opposition from the Calvinist Church in Scotland on the grounds the Bible stated �In sorrow thou shalt bring forth children� showed women must suffer when giving birth. The Calvinist church opposition disappeared when Queen Victoria gave birth to her eighth child under the influence of chloroform. However, chloroform was soon discovered to have its own problems as it could cause liver damage and five times as many people died under chloroform as died under ether.

The method of application of the anaesthetic developed over time. Long had simply poured ether into a towel for his patient to inhale. Morton used an inhaler made up of a round glass bottle with two holes and a mouth piece. Air passed through one hole into the bottle which contained a sponge soaked in the ether which was then inhaled by the patient through the mouth piece which was attached to the other hole. Morton�s inhaler did not allow the anaesthetist to have control over the amount of anaesthetic. Soon John Snow, who had provided the chloroform to Queen Victoria, created an improved inhaler which provided a 4% mix of chloroform in air. Joseph Clover produced a further improved inhaler in which the chloroform and air mixture was prepared in advance and held in an air tight bag. Sir Francis Shipway created an apparatus which allowed the anaesthetist to control a mixture of varying amounts of chloroform, ether and oxygen for inhalation by the patient.

A significant improvement in the provision of anaesthetics occurred with the introduction of the anaesthetic directly into the windpipe or trachea. This was first attempted by Frederick Trendelenburg, in 1869, who inserted the anaesthetic through a tube he inserted into a hole he had cut into the patient�s windpipe. Sir Ian Macewan achieved the same result without cutting into the windpipe, in 1880, by inserting a metal pipe the throat and into the windpipe. This allowed the development of endotracheal anaesthesia which was important for operations on the mouth and the jaw and for many modern cardiac and pulmonary operations. Endotracheal anaesthesia was further improved, in 1919, when Sir Ian Magill put tubes through the conscious patient�s nose and mouth and down into the windpipe by anaesthetizing the throat with cocaine before inserting the tubes.

General anaesthetics were often not necessary for minor operations. A local anaesthetic which worked on a particular part of the body and avoided the small risk of death and several hours of recovery time involved with general anaesthetics was sought. Peruvian Indians knew about the anaesthetic qualities of the coca plants and in the nineteenth century cocaine was obtained from the plant. In 1872 Alexander Bennett observed that cocaine had anaesthetic properties and in the 1880�s Carl Koller experimented with cocaine using it to anaesthetize frog�s eyes. Soon cocaine began to be used as a local anaesthetic for eyes, the mouth, nose and throat and in the urethra. The use of cocaine was extended by injecting it into the nerves relating to the area to be operated on and eventually into the epidural space around the spinal cord which allowed a larger area to be anaesthetized. The use of cocaine as a local anaesthetic has discontinued with its replacement by novocaine which was synthesized as an aesthetic after 1905.

1.3.4 THE GERM THEORY OF DISEASE�� (back to content)

The first person to see micro-organisms was Anthony Leeuwenhoek (1632-1723) a Dutch draper who was an expert maker of microscopes. His microscopes gave a degree of magnification which was not exceeded until the 19th century. He used his microscopes for observing a wide variety of phenomena. In 1675 and 1676 he looked at drops of rain water and found tiny animals within the water. Those animals would have included what we now call bacteria and other micro-organisms. In 1683 Leeuwenhoek looked at plaque from his own teeth and found it contained large numbers of small animals. Later samples of plaque did not contain the small animals, which Leeuwenhoek suspected was because his drinking of hot coffee killed the little animals. Leeuwenhoek also looked at scrapings from his tongue when he was sick and at the decay in the roots of a rotten tooth he had removed. In both cases he found vast numbers of the little animals. The presence of these animals in such great numbers in places of illness and decay raised the question as to whether the animals arose from the decay or whether they were attracted to it or whether they caused the decay. The question of whether the small animals were spontaneously generated from decaying materials or were attracted to it was the subject of much controversy. Francesco Redi (1626-1698) kept boiled meat in sealed containers and when maggots failed to appear suggested this showed there was no spontaneous generation. However, in 1748 John Needham repeated the experiment and found small animals in the meat which he considered proved spontaneous generation. Lazzaro Spallanzoni suggested Needham had failed to seal his containers properly so that the small animals arrived on the meat through the air, rather than being spontaneously generated by the meat. Supporters of spontaneous generation argued that sealing the containers prevented some gaseous substance, necessary for spontaneous generation, from reaching the meat and so preventing the generation of the living organisms.

Whether micro-organisms caused the diseases they were so often found with, was investigated by Agostino Bassi. In 1835 he showed that the silkworm disease, muscarine, was caused by bacteria. When he inoculated healthy silkworms with the bacteria, he produced the sickness in the silkworms. This suggested that other diseases may be caused by bacteria.

The questions of spontaneous generation and whether micro-organisms played any role in causing disease were eventually settled by Louis Pasteur. He was to show that fermentation in wine, putrefaction of meat and infection in human disease all involved the same process and were all caused by the activities of micro-organisms. The micro-organisms were generated not by decaying matter but were continually present in the air and when they were present in great numbers and were of unusual strength they could cause matter to decay and human beings to fall ill.

� Pasteur began with fermentation in wine. At the time chemists such as Wohler and Justus von

Liebig suggested fermentation was solely a chemical process with living organisms playing no role in the process. Fermentation in wine was a problem as sometimes the fermentation went wrong and soured the wine. Pasteur showed that fermentation was caused by micro-organisms in yeast and that round yeast cells produced good wine, but long yeast cells created lactric acid which caused the wine to go sour. Pasteur showed that if the wine was heated it would kill the yeast and stop any of the wine going sour.

Pasteur next began to investigate putrefaction in meat with an experiment that allowed air to reach boiled meat via an undulating u shaped tube. The meat did not putrefy and Pasteur considered this was because the dust particles containing the micro-organisms were caught on the low bend of the tube as they could not travel up the tube due to gravity. The micro-organisms did not reach the meat even though it was exposed to air so the meat did not putrefy. This showed it was not air that caused putrefaction, but micro-organisms in the air.

Pasteur then began to investigate diseases in living organisms, first with silkworms and then anthrax which affects sheep and cattle and occasionally humans. Pasteur showed the disease killing silkworms were two different sorts of micro-organisms which caused two different diseases in the silkworms. In relation to anthrax it was already known that the blood of cattle, which had died from anthrax, contained micro-organisms and that these micro-organisms were the cause of the disease. Robert Koch had discovered the anthrax bacteria, had cultured it, and injected it into animals which had immediately died. He also found that anthrax micro-organisms could sometimes form spores, which were tiny organisms� resistant to a range of environmental conditions. The spores were formed when the temperature was right and oxygen was present. Once the spores were formed they could survive for a considerable time and re-infect other animals making the disease difficult to control. Pasteur, with some difficulty, then produced an anthrax vaccine which he used to inoculate sheep which were later injected with the anthrax bacteria. The sheep did not develop anthrax and Pasteur had found a vaccine for anthrax.

Pasteur�s last great achievement was to discover a vaccine for rabies. Rabies normally occurs in humans after they have been bitten by a rabid dog with the symptoms appearing between 10 days and several months after the dog bites took place. Pasteur studied the tissues of rabid dogs but could not find a micro-organism that could have caused rabies. He decided the organism was too small to be detected with a microscope. Pasteur considered the micro-organism entered the body through the bite wound and over time moved to the brain, explaining the period of time between the bite and the arrival of symptoms. After some time, Pasteur was able to produce a vaccine for rabies which was able to be injected in the period after the dog bite and before the onset of symptoms.

Pasteur�s work had followed a logical path. He had first shown that fermentation was caused by micro-organisms, and that those micro-organisms originated in the air rather than from the fermenting matter and that micro-organisms also caused putrefaction and infectious disease. He then showed how the diseases in both animals and people could be cured by vaccination. Pasteur�s work established the germ theory of disease and put an end to other theories of disease such as the humoral theory.

Robert Koch, after isolating the anthrax bacteria, began using an improved microscope with a light condenser and an oil immersion lens. This enabled him to see bacteria that had previously been too small to be seen even with the best microscopes available. He also used new aniline dyes which helped him to distinguish between different types of bacteria. Koch also found a way of producing pure cultures of different types of bacteria by placing the bacteria on a solid culture medium, in place of the liquid culture medium then currently used, which only worked well with bacteria that moved in the blood stream. With his improved microscope and better techniques for creating pure cultures of bacteria Koch began to search for a tuberculosis bacterium, in the tissue of humans who had died of tuberculosis. Using a microscope equipped with the oil immersion lens and condenser that was five times as powerful as Leeuwenhoek�s microscopes he was able to find a tiny bacterium which he called the tubercle bacillus. The tubercle bacillus was much smaller than the anthrax bacteria and was too small to be found without the use of his new improved microscope. To prove the tubercle bacillus caused tuberculosis Koch needed to isolate it in a pure culture and to inject it into various animals. If it produced tuberculosis in those animals that would prove the tubercle bacillus was the cause of tuberculosis. After some difficulty he was able to produce a pure culture of the tubercle bacilli. He then injected this into animals which soon became sick and when he examined their diseased tissues he found they had tuberculosis. Koch had found the cause of tuberculosis giving hope that a cure would eventually become possible.

If Pasteur established the germ theory of disease, it was Koch who was to turn bacteriology into a science. Koch formalized the methods for studying micro-organisms and proving their relationship with particular diseases. To prove an organism was the cause of a disease Koch proposed the following criteria, which came to be known as Koch�s postulates:

1. The organism must be present in every case of the disease.

2. It must be possible to prepare a pure culture, maintainable over repeated generations.

3. The disease must be reproduced in animals using the pure culture, several generations removed from the organism originally isolated.

4. The organism must be able to be recovered from the inoculated animal and be re-produced again in a pure culture.

Clearly the third and fourth postulates can only apply to diseases which apply to animals as well as humans and the postulates were not able to be applied to all micro-organisms for example viruses. Nevertheless, the postulates provided a set of procedures for the investigation of diseases which were to establish the causes of a range of diseases which opened up the possibility of finding cures and treatments for the diseases. Between 1879 and 1906 the micro-organisms causing many diseases were discovered. The diseases involved included gonorrhoea (1879), typhoid fever (1880), suppuration (1881), glanders (1882), tuberculosis (1882), pneumonia (1882 and 1883), erysipelas (1883), cholera (1883), diphtheria (1883-4), tetanus (1884), cerebrospinal meningitis (1887), food poisoning (1888), soft chancre (1889), influenza (1892), gas-gangrene (1892), plague (1894), pseudo-tuberculosis of cattle (1895), botulism (1896), bacillary dysentery (1898), paratyphoid fever (1900) syphilis (1905), and whooping cough (1906). The discovery of the micro-organism causing the disease did not always result in effective treatments.

1.3.5 ANTISEPTICS�� (back to content)

The increase in surgery produced by the use of anaesthetics simply highlighted another problem, the death of large numbers of patients due to infection. Patients dying from infection had long been a problem both in obstetrics and surgery. It was in obstetrics that the first understanding of the causes of infection arose, but it was in surgery that the solution to the problem was achieved.

Some doctors and surgeons sensed that a lack of cleanliness may be the cause of infection. Charles White in 1773 in Manchester suggested the cleaning of the surgery room, clothing and articles in contact with the patients but did not refer to cleansing of surgeons and others involved in operations. Alexander Gordon (1752-1799) suggested infection was carried from infected patients to uninfected patients. He suggested the cleansing of surgeons but did not realize that infected matter was involved in the spread of disease.

In the mid nineteenth century Ignaz Semmelweis was working at the maternity clinic at Vienna General Hospital.� He noticed that the section of the hospital used for training medical students in obstetrics had a much higher rate of mortality, around 13% than the section used to train midwives, which was around 2-3%. Explanations considered for the variations in the mortality rates included that the poor single mothers and prostitutes in the hospital were less embarrassed when treated by women. Semmelweis noticed that the puerperal fever which killed many of the women immediately after they had given birth seemed to be the same disease that had killed the surgeon Jakob Kolletschka who died after cutting his finger in a post mortem. Later Semmelweis realized that medical students going to their section of the maternity clinic came from anatomy classes involving dissections and the handling of diseased body parts. Little attempt was made to clean up between the anatomy classes and the work done in the maternity clinic. Semmelweis suspected the students coming from the anatomy classes were bringing infection into the maternity clinic so he ordered students to wash and scrub in a chlorine solution before entering the maternity clinic. Within a month the mortality rate in the students� section dropped to 2% the same as for the midwives� section. Despite his success Semmelweis became very unpopular with the medical students, his immediate superior and even the patients who felt he was suggesting they were dirty. Semmelweis left Vienna for a hospital in Budapest where he instituted similar hygienic reforms and again the mortality rate dropped dramatically. He published a paper on his discoveries, which was ignored, and then a book which was also ignored. Semmelweis then began to behave erratically writing angry letters to those who criticised his work. He was soon induced or forced to enter a mental hospital and within two weeks was dead in circumstances that may have amounted to murder.

Joseph Lister was a surgeon in Glasgow who noticed that the mortality rate for compound bone fractures where the bone was exposed to the air were much higher than for broken bones where there was no exposure to the air. Broken bones exposed to the air often developed gangrene which was usually blamed on �miasma� or bad air. Lister did some experiments on frogs legs and concluded that gangrene was a form of rotting, involving the decomposition of organic material. He also read Pasteur�s work which suggested that putrefaction was the rotting of organic material caused by bacteria in the air. Lister accepted Pasteur�s idea that it was not the air that caused the gangrene but bacteria in the air.

The question was how to destroy the bacteria both in the air and in the wounds. Carbolic acid or phenol had been isolated in the 1830�s through coal tar distillation. It was used to clean sewers and after various experiments with crude carbolic, which killed tissue, Lister began to use carbolic acid. He would dress wounds in lint soaked with carbolic acid and sprayed the air in the operating room with carbolic acid. Lister published his work in 1867 in a paper entitled On the Antiseptic Principle in the Practice of Surgery. The mortality rates from Lister�s amputation operations fell from 45% to 15%, but despite this some doctors still refused to believe that bacteria existed or could cause infection. However, the results of using Lister�s methods soon became obvious and they began to be used throughout Europe. Over time he refined his procedures getting rid of the carbolic spray and putting greater emphasis on using heat to sterilize dressings and instruments. There was also a move from anti-septic measures which destroyed germs in wounds to aseptic measures which ensures that everything that touches the wound such as instruments and the surgeon�s hands are free from germs.

Towards the end of the 19th century sterilized gowns, masks, caps and rubber gloves were introduced for surgical operations.

1.3.6 ANTIBIOTICS�� (back to content)

Scientists experimenting with bacteria had on various occasions noticed that penicillin and other biological organisms could inhibit the growth of bacteria. In 1875 John Tyndall had observed penicillin had killed bacteria in some of his test tubes. In 1877 Pasteur had noted anthrax bacilli grew in sterile urine but the addition of �common bacteria� stopped the growth.� In 1885 Arnaldo Canteri noted certain bacterial strains killed tubercle bacilli and reduced fever in the throat of a tubercular child. In 1896 a French medical student noted that animals inoculated with penicillin and a virulent bacterium did better than animals inoculated with the virulent bacteria only. In 1925 D A Gratia noted that penicillin could kill anthrax bacilli.

Alexander Fleming was experimenting with bacteria in 1928 when he observed bacteria in his petri dish had been killed by the Penicillium mould. Fleming began experimenting with the mould and soon isolated the substance that killed the bacteria. He called the substance penicillin and then tested its effectiveness against other bacteria. He found penicillin could kill a range of bacteria but there were some bacteria it did not affect. He injected it into animals and found that it did not do them any harm. Fleming then published his results in 1929 and then in a briefer report in 1932. Fleming�s work was largely ignored and he then turned his research interests elsewhere. The prevailing scientific view at the time was that anti-bacterial drugs would not work against infectious disease and would be so toxic to use on humans.�

This belief to change 1935 when it was that Prontosil could destroy streptococcal infection when given intravenously. Research on penicillin only began again in 1940, in Oxford, when Howard Florey and Ernest Chain discovered penicillin was an unstable simple molecule. They were able to stabilize it by freeze drying it in a water solution. This produced a powder that was tested on mice and did not harm them and cured them of streptococci. It was also discovered that penicillin could travel through the body to attack infections wherever they were. Their results were published in August 1940 and Florey, Chain and their colleagues began to manufacture penicillin as fast as possible.

The first human test of penicillin was on a badly ill policeman. The policeman improved until he seemed on the verge of total recovery when the supply of penicillin ran out and the policeman relapsed and died. More penicillin was manufactured and tested on humans and was found to regularly clean up infections. It was found to be effective against most forms of pus forming cocci and against tetanus, anthrax, syphilis and pneumonia. The manufacture of penicillin was greatly expanded when the United States began to produce it and new manufacturing techniques involving deep fermentation were developed. This involved submerging the mould below the surface of the culture medium. Eventually semisynthetic penicillins and penicillins that could be swallowed were produced.

Eventually a systematic search began for other anti-biotics. Howard Florey outlined the procedure to be followed which involved the investigation of micro-organisms to find out which ones produced an anti-bacterial substance, the isolation of that substance, testing the substance for toxicity, testing it in animal experiments and then testing it on people. The search for new anti-biotics was to produce a substantial number of new anti-biotics including streptomycin developed in 1944 which was effective against tuberculosis. Chloramphenicol, developed in 1949, was effective against typhoid fever. Anti- biotics were eventually found that could act against every bacteria that causes diseases in humans. Some of those bacteria are now developing resistance to anti-biotics and the development of new anti-biotics is inhibited by the extreme cost, running into hundreds of millions of dollars, of obtaining United States government approval for the drugs. Nevertheless, anti-biotics have saved hundreds of millions of lives.

1.3.7 MEDICAL STATISTICS�� (back to content)

The use of statistics in medicine to determine the cause of disease or the success of a treatment has a relatively short history. In the past the causes of disease and the success of treatments were usually decided by physician�s personal experience with patients, which, assuming that physicians had similar experiences, led to accepted beliefs as to the efficacy of treatments and the causes of disease. The beliefs would be recorded in authoritative medical texts and would in many cases become a sort of medical dogma. Disputing the dogma could involve accusations of unorthodox opinions that could lead to bad practices that could endanger patients� lives.

The idea of doing trials, to test the effectiveness of medical treatments, was suggested by the scientist, Johannes van Helmont and the philosopher George Berkeley. The first known trial to assess the cause of a disease seems to have been done by James Lind in an attempt to discover the cause of scurvy. Scurvy was killing large numbers of sailors on long sea voyages. Lind took 12 scurvy sufferers and divided them into 6 groups of 2 and each group was given a different dietary supplement. The two sailors given oranges and lemons rapidly recovered and the others did not.� Lind eventually published his findings, and although there remained some confusion for some time, eventually lemon juice became standard on long sea voyages.

One question, much debated in the 18th century, was whether smallpox inoculation was a good thing. In England inoculation was generally favoured, in France it was opposed. Various calculations were made as to the death rate from smallpox which was considered to be around one in ten, excluding fatalities of those under 2 years old. Other calculations were 1 in 12 and 1 in 7. This was compared to the death rate from inoculation which James Jurin, secretary of the Royal Society, calculated at 1 in 91. The Swiss mathematician, Daniel Bernoulli calculated that inoculation increased the average life expectancy by two years. A further problem was that people inoculated with smallpox could spread it to others and this was not taken into account in calculating death rates from inoculation. If people who were inoculated could be isolated for a period, then the figure might not be too high, but then if people who got smallpox naturally were isolated that would reduce the death rate from normal smallpox. An additional problem was that the rate of smallpox infection varied considerably from large cities where nearly everyone would, sooner or later get smallpox and the small towns and villages where most people in the 18th century lived, and many people could live their lives without getting smallpox. Modern estimates of the death rate from inoculation are as high as 12%, not much better than the death rate from normal smallpox infection.

The difficulty in calculating accurate death rates for inoculation and normal smallpox infection, how to introduce into the figures people who caught smallpox from those who were inoculated and how to deal with the widely varying rates of smallpox infection between urban and rural areas gives some idea of the difficulty in working out whether inoculation was a good thing or a bad thing. The whole debate eventually became irrelevant when vaccination with cowpox, a quite safe form of immunization became available at the end of the 18th century. A further illustration of the problem of accurate statistical analysis of medical treatments is contained in the work of Pierre Louis in the first half of the nineteenth century.� Louis conducted several trials to test bloodletting as a treatment for various inflammatory diseases. He concluded from his trials that bleeding resulted in patients recovering earlier than if there was no bleeding and that if bleeding is done, patients bleed earlier during the course of the disease recovered more quickly than those bleed later. However, the way Louis conducted the trial was not ideal. Those bleed earlier during the illness were on average 8 years and 5 months younger than those bleed later, which could explain the faster recovery. A further criticism of Louis�s study was that the numbers involved in his trial were insufficient so there was a wide margin of error in his results so they were not reliable.

A more successful use of statistics to discover the cause of disease occurred in the mid-19th century when John Snow discovered the cause of cholera. Cholera was like many infectious diseases, assumed to be caused by miasma or bad air caused by putrefaction. Snow suspected that cholera could be transmitted by personal contact and through polluted water supplies. He examined the sources of the water supplies in London and compared it to mortality rates from cholera. Areas with clean water supplies, due to water being taken from the Thames above sewage outfalls, or with filtered water, or with water passed through settlement ponds, showed much lower rates of cholera than areas using unfiltered and unponded water taken from below sewage outlets. Areas with clean water had a death rate of 10 per 10,000 from cholera, areas with polluted water had a death rate of 110 per 10,000 from cholera.

Snow also investigated the cholera levels for households in the same areas, where the water supplies came from two separate companies, one of which supplied clean water to its customers and the other which supplied polluted water. Those customers obtaining clean water had 5 cholera deaths per 10,000, those obtaining polluted water had 71 cholera deaths per 10,000. The 5 cholera deaths per 10,000 could have been caused by visiting houses, pubs and cafes with polluted water and people who had fallen sick with cholera.

Snow�s final study concerned a small area around Broad Street in London where 500 people died of cholera in ten days. Snow suspected a water pump supplying drinking water in the centre of the area could be responsible so he asked the local authority to remove the handle from the pump. This was done and the cholera outbreak ended. More particularly Snow showed certain groups within the Broad Street area, people in a workhouse and those working in a brewery who did not use water from the pump had an unusually low cholera death rate. He also showed that certain individuals from outside the Broad street area who drank water from the pump also died of cholera within the ten day period.

Snow�s three studies provided powerful evidence that polluted water caused cholera but his findings were initially rejected. Two inquiries considered cholera still came from bad air and another study which concluded that the death rate from cholera rose as one moved from highlands to sea level also suggested bad air was to blame. Eventually, when miasmic theories of disease lost creditability with the rise of the germ theory of disease, Snow�s explanation of cholera was accepted.

The first truly scientific randomised control test was that conducted on the drugs streptomycin and PAS as a treatment for tuberculosis. Tuberculosis was in the mid twentieth century, the most common fatal infectious disease in the western world. Its cause, the tubercle bacillus, had been identified by Robert Koch in 1885, but no effective treatment had been found for it. Antibiotics like penicillin did not work against it, as it had an impermeable waxy coat that protected it from antibiotics.

A new drug called streptomycin had been discovered in America in 1944 which seemed to work against tuberculosis germs. It inhibited the growth of tuberculosis bacillus on ager plates and was successful at curing tuberculosis in guinea pigs and when tried on a human patient with five courses of treatment between November 1944 and April 1945, cured the human patient. A second drug which showed promise as a tuberculosis treatment was PAS. It had been noted that Aspirin resulted in the tuberculosis bacilli absorbing increased amounts of oxygen and it was considered that a similar drug to Aspirin might block the supply of oxygen to the tubercle bacilli. PAS was tried and was shown to cause an improvement in the condition of tuberculosis patients. Immediately after World War II Britain was short of money and could afford only a very small amount of streptomycin. The Tuberculosis Trial Committee, encouraged by one of its members Austin Bradford Hill, recognised there was not enough streptomycin to provide to all patients, decided to conduct a random control test with the streptomycin, providing streptomycin to one set of patients and comparing the results with another set of patients not receiving the drug. There was enough streptomycin to provide to 55 patients and the results of the treatment were compared with 52 patients who received the usual treatment provided for tuberculosis patients. Which patients received the streptomycin and which received the usual tuberculosis treatment was decided completely at random to avoid any conscious or unconscious bias in the allocation of patients to either group.

Six months after the trial had begun it was found that only four patients had died from the group given streptomycin while fourteen had died from the group receiving the conventional treatment. Streptomycin seemed to be an effective treatment with significantly fewer deaths in the group receiving the streptomycin. However, a follow up investigation three years later revealed 32 of the group using the streptomycin had died compared to 35 in the group not receiving the drug. After three years the group using the streptomycin was only slightly better off than the group not using it. What had happened was that over the period of treatment some of the tubercle bacilli had become resistant to the streptomycin and when this happened patients who initially seemed to be getting better, worsened and often died. The test revealed that not only did streptomycin not work in the longer term but that there was a problem of the bacilli becoming resistant to the streptomycin which, if it could be overcome could mean that streptomycin could still be an effective treatment for tuberculosis. If the drugs had simply be provided to doctors for treating patients it would have taken much longer to work out why it was not working.

A further trial was conducted which combined streptomycin with PAS with the aim ofovercoming the problem of resistance from the tubercle bacilli. In the second trial resistance to streptomycin developed in only 5 patients compared to 33 in the first trial. The combination of the two drugs proved to be an effective treatment for tuberculosis and survival rates for tuberculosis patients went up to 80%. Eventually other drugs such as isoniazid and rifampicin were introduced and it was found that combining three drugs resulted in survival rates approaching 100%.

Random controlled trials were also found to be effective in proving the causes of certain diseases. After World War II the great majority of the adult population smoked and lung cancer deaths were rapidly increasing. Bradford Hill, Edward Kennaway, Percy Stock and Dr Richard Doll were asked to investigate whether smoking was a cause of the increasing number of lung cancer deaths. Smoking was only one possible explanation, others such as increased air pollution especially from motor vehicles were considered to be as likely or more likely the cause of increased lung cancer deaths, than smoking. The asphalting of roads was considered to be another possible cause of the escalating lung cancer deaths. Given that most adults smoked it was difficult to find a suitable control group of non-smokers. The investigation was conducted by creating a detailed questionnaire which patients suspected of having lung cancer completed. The questionnaire was also completed by patients who had other cancers and also by patients in hospital for reasons other than cancer to act as two control groups. It was found that 99.7% of the lung cancer patients smoked against 95.8% of the control group patients. This was not a great difference but it was also found that 4.9% of the lung cancer patients smoked 50 cigarettes a day as opposed to only 2% of the control group patients.

The lung cancer rate amongst those smoking 50 cigarettes a day was over double for lung cancer patients than for the control group. The more people smoked the greater their chances of getting lung cancer. The study conducted by Doll and Bradford Hill had looked at lung cancer patients and looked back in time at their smoking habits. They then decided to do a study of healthy people investigating their smoking habits and then observing how their health developed in the future. Doll and Bradford Hill decided to do the study on doctors, 40,000 of whom filled in and returned their questionnaire. Two and a half years later enough doctors had died for Doll and Bradford Hill to be able to show that the more the doctors smoked the greater the likelihood they had died of lung cancer. It was eventually found that doctors smoking 25 cigarettes per day were 25 times as likely to develop lung cancer compared to non- smokers.

The success of the random control tests on streptomycin and in showing that smoking caused lung cancer led to random control tests becoming standard practice to test new drugs and to identify the causes of disease. The testing has had its undesirable side with the testing costs running to hundreds of millions of dollars and so discouraging the production of new drugs and some studies of disease showing a relationship between environmental factors and the disease without giving any real indication of a cause and effect relationship.

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1.3.8 DIAGNOSTIC TECHNOLOGY

The twentieth century has seen the development of a series of new technologies that have enabled physicians to see inside the human body. The technologies began with X-Rays, and then CT scanners, PET scanners and MRI scanners were developed. These technologies all allowed physicians to see inside the body from the outside while other technologies such as endoscopy allowed physicians to invade the body with tiny cameras to observe the state of the interior of patients bodies.

X-Rays were first discovered by Wilhelm Roentgen in 1895. Roentgen was experimenting with a Crookes tube, a glass tube with the air removed to create a vacuum and with electrodes to allow the production of an electric current within the tube. The electric current, consisting of a stream of electrons known as cathode rays, would cause phosphorescent material within the tube to glow.� When experimenting with a Crookes tube, the German physicist, Phillip Leonard has noticed that cathode rays could travel through an aluminium sheet he had placed over a window in the Crookes tube and turn slips of paper covered with barium platinocyanide salts, fluorescent. Lenard sent a Crookes tube to Roentgen for Roentgen to study the cathode rays. Roentgen repeated Lenard�s experiments and found the cathode rays were escaping from the Crookes tube just as Lenard had found. Roentgen thought that the cathode rays might be passing through the walls of the Crookes tube as well as through the aluminium covered window in the tube.

When conducting the experiment Roentgen noticed a screen coated with barium platinocyanide, a yard away from the Crookes tube, turned fluorescent. This could not be caused by cathode rays which only travel a few inches in the air. Roentgen moved the screen further away from the Crookes tube and the screen still turned fluorescent when he turned on the electric current in the Crookes tube. Roentgen placed objects like a book and a deck of cards between the Crookes tube and the screen and the screen still lit up when he turned on the current in the Crookes tube. Further experiments revealed, that the ray causing the screen to light up, could penetrate a wide range of materials such as wood and flesh. Roentgen had no idea what the ray was so he called it an X-ray. When a human hand was placed in front of a photographic plate and exposed to X-rays, the plate showed the bones in the human hand. However, the X-rays did not easily pass through metals and could not pass through lead at all.

X-rays were found to have a number of uses such as in crystallography, astronomy and in microscopic analysis, but their most important use has been in medicine. X-rays can provide a photograph of the inside of the human body. X-rays have a shorter wave length than light so they can penetrate materials opaque to light. X-Rays can more easily penetrate materials of low density such as skin and muscle, but cannot penetrate materials of higher density, such as bone, bullets and kidney stones.

The use of x-rays in medicine was greatly extended by the employment of contrasting media such as barium salts and iodine solutions. Barium makes it possible to obtain x-rays of the large and small intestine and the stomach and the oesophagus. Iodine allows an x-ray picture of the kidneys and bladder and also the carrying out of angiographs. Angiography provides a view of the blood within the arteries and veins which will disclose blockages and other problems within the arteries and veins. The use of catheters allows contrast materials to be injected into the heart allowing x-rays of the internal structures of the heart. X-rays can be used to detect tumours, cancers and cysts.

A further enhancement of x-ray technology came with the development of CT or CAT scanners. The CT scanner uses x-rays, photon detectors and computers to create cross section images or tomograms of the human body. In 1963 Allan Cormack invented an improved x-ray machine using computers, an algorithm and tomograms. In 1972 Godfrey Hounsfield invented the CT or computerized tomography scanner. It allowed many x-rays to be taken, from multiple angles of thin slices of the human body and detectors opposite the x-ray tubes would collect the data, which was converted into digital data, which was then converted by an algorithm, a set of mathematical instructions, by a computer into x-ray pictures. The CT scanner could give three dimensional views of the body and provides much better resolution than ordinary x-ray images. It can show soft tissues and liquid parts of the brain and can show tumours as small as one or two millimetres in size. CT scanners have gone through a series of improvements involving various different generations of scanners. In the earlier scanners the x-ray beam lacked the width and the number of detectors to cover the complete area of interest requiring multiple sweeps to produce a suitable image. In subsequent scanners a wider x-ray beam and more detectors were used to shorten scanning times.

Endoscopy, also known as laparoscopy, involves inserting an instrument into the body either through the body�s natural entrances or through a small hole surgically cut in the body. The instrument is used to observe the internal structures of the body and can also be used for surgery with tiny instruments at the end of the endoscope being manipulated by the surgeon through the endoscope.

Endoscopy goes back to the late nineteenth century but was not widely used as the views it provided of the interior of the body were too poor for practical use. Harold Hopkins, a physicist, heard about the problems with endoscopes and remembered that although light normally travelled in a straight line it could in certain circumstances be made to travel around corners by the use of curved glass. Hopkins considered that tens of thousands of flexible glass fibres operating together may be able to cause light to go around corners. He made an experimental endoscope and published his results in 1954. Basil Hirschowitz, a South African, working in the United States, read about Hopkins ideas and created his own endoscope. Several hundred thousand fibres were wound together and to stop light jumping from one fibre to another which could cause the loss of the image a technique of coating each fibre with a glass coating was developed. The endoscope allowed investigation of much of the interior of the body and some surgery on the interior of the body without having to make substantial incisions into the body.

Photography through an endoscope was not very satisfactory due to inadequate illumination and because the optical system was not good enough. Hopkins investigated the problem and found that an endoscope consisting of a glass tube containing thin lenses of air gave improved light transmission around eighty times stronger than conventional endoscopes made of an air tube containing thin lenses of glass. This allowed the taking of photographs through the endoscope and allowed greatly expanded surgical possibilities through the endoscope. Endoscopy can be used for surgery by instruments such as lasers or wire loop cautery devices attached to the head of the endoscope and controlled by the surgeon through the endoscope.

1.3.9 MODERN SURGERY�� (back to content)

Surgery, before the introduction of anaesthetics and anti-septic and aseptic practises, was limited to a narrow range of operations, of which limb amputation was by far the most common. The quickest operations only were possible without anaesthetics and the mortality rates from infection were enormous before anti-septic practices were introduced. The introduction of gowns, masks, rubber gloves and the sterilization of instruments dramatically cut the death rate in surgery.

Abdominal surgery only became possible with anaesthetics and anti-septics. Christian Billroth (1829-94) pioneered operations in this area. Operations to remove the appendix and to close a perforated gastric ulcer began to be performed in the late 19th century. Brain surgery began with Sir William Macewan (1848-1924) in Glasgow and Macewan also developed operations to deal with bone diseases such as rickets.

Plastic surgery was to make great progress in the 20th century, two New Zealanders Harold Gilles and Archibald McIndoe leading the way. Plastic surgery dates back to ancient times and was practiced in pre-British India and Renaissance Europe when it was used to deal with the terrible damage caused by syphilis. During World War I Harold Gilles carried out plastic surgery on the badly disfigured faces of soldiers and sailors. He developed an operation whereby a skin flap was sliced from the upper arm, one end of the flap remaining attached to the arm and the other end was moulded over the nose and then sewn down. After several weeks the skin sewn to the face would take and the skin attached to the arm could be cut and sewn into place on to the face. When the injured had no facial skin at all Gilles took the flap of skin from the abdomen rolling it over the chest and sewing one end to the face. Holes would be cut in the skin for the nose, eyes and mouth. When that end had taken Gilles cut the end still attached to the abdomen and then sewed that into place on the face. This system involved two operations as if the skin was completely removed from the donor area before it had taken on the face it would die due to lack of blood supply. These techniques were further developed by Archibald McIndoe while operating on air force pilots injured in World War II.

The first experiments with organ transplants had been made by Alexis Carrel early in the 20th century. He carried out various transplant operations on animals discovering the problem of rejection where the transplanted organ was rejected by the receiving animal�s body. The problem of rejection was investigated by Peter Medawar when he observed skin drafts taken from a donor would last for ten days before rejection, while a subsequent skin draft from the same donor was instantly rejected. When the body suffers an infection from bacteria or viruses initially it takes time to identify the invading organism before the immune system attacks the invading organism. In the event of a subsequent attack by the same organism the organism is immediately attacked because the immune system recognizes it as foreign material due to its previous contact with the virus or bacteria. The way in which the first rejection takes some time but a second rejection of the same material occurs immediately led Medawar to realize that it was the immune system rejecting the transplant in the same way as it attacked invading bacteria and viruses.

Organ transplant required a practical surgical technique which was developed by Joseph Murray who improved on techniques experimented with by Alexis Carrel on animals. The technique involved the sewing together of small blood vessels which allowed the attaching of the transplanted organs blood supply to those of the recipient so that it could receive the receipts blood. The first attempts at organ transplant were kidney transplants. This was because humans had two kidneys, but only need one so living donors were readily available. Kidney transplants were also relatively straight forward operations the main job being to connect the transplanted organs blood supply to the recipient�s blood supply.

Kidney transplants did however require the prior invention of the kidney dialysis machine. The dialysis machine was invented by Wilhelm Kolff, a Dutch physician in 1941. The dialysis machine performs the work of the kidneys when the kidneys fail. This mainly involves removing waste material from the blood. The dialysis machine is needed during transplants to keep people alive before the operation and for a period of time after the operation, often ten days or so, until the donated kidney begins to work.

A workable surgical technique and the dialysis machine allowed kidney transplants to be performed and the first operation was performed in 1954 by Joseph Murray on a patient whose identical twin supplied the donated kidney. The operation was a success with no rejection problems as the donated kidney came from an identical twin so that the recipient�s immune system did not treat the donated kidney as foreign material. When however, kidney transplants were attempted using close relatives as donors, the donated organs were rejected by the recipient�s immune system resulting in the death of the recipient.

A drug, known as 6-mp, had been developed by George Hitchings and Gertrude Elion as a treatment for leukaemia. 6-mp worked by stopping the cancer cell from dividing by appearing to be a chemical necessary for the cancer cells division, but which was slightly different so that it stopped the cancer cell from dividing and so killed the cancer cell. 6-mp was tried to stop the immune system rejecting transplanted organs by stopping the division of cells in the immune system. 6-mp was tried on rabbits and found to stop the rabbit�s immune system attacking foreign material, but leaving the rabbits immune system otherwise working. Hitchings and Elion also developed a new drug azathioprine that was an improved version of 6-mp. Azathioprine was tried on people but with poor results until high doses of steroids in short bursts were given to patients with the azathioprine. This had the desired effect of preventing the immune system attacking the transplanted organ while still leaving the immune system able to work against ordinary infections. Eventually another drug cyclosporine was developed which had the same effect and transplant operations for other organs such as the lungs, liver, bone marrow and hearts were developed.

Improvements in medicine and sanitation led to people living longer and an increasing exposure to the diseases of old age. Arthritis became much more common in the twentieth century than previously. Arthritis of the hip was particularly a problem causing constant and serious pain to patients and greatly reducing mobility. The pain was caused by the rubbing of bone against bone in the hip due to the erosion of cartilage between the bones.

Some attempts had been made to provide artificial hips in the 1930�s and 1940�s but none had been particularly successful. A major difficulty was that the hip has to maintain the weight of the body as well as being completely mobile.� John Charnley looked at problem and came up with three innovations that were to lead to a practical artificial hip. He redesigned the socket, he cemented the artificial hip to the bones with acrylic cement and he lubricated the joint first with Teflon and then when that failed with polyethylene. Charnley�s new artificial hip was an outstanding success and the hip replacement operation was to become a common operation in the late 20th century.

The heart is the most complex organ in the body and for the first half of the twentieth century surgeons did not touch it believing that to do so would kill their patient. In the 1930�s and 1940�s operations were carried out on the aorta and the pulmonary artery to ease symptoms caused by heart problems, but the heart itself was not touched. In the late 1940�s surgeons began to widen heart valves through a hole cut in the wall of the heart while the heart was still working. However, much heart surgery, known as open-heart surgery, was only possible with the heart being stopped. If the heart was stopped some means of maintaining the blood supply to the body was necessary or the patient would die. John Gibbon and his wife Mary Hopkins began work on a machine that could perform the work of the heart and lungs in the 1930�s. The machine needed to be able to add oxygen and remove carbon dioxide from the blood and to pump the blood through the body. The machine needed valves to ensure the blood all flowed in one direction and had to use glass tubes as plastic had yet to be invented. The Second World War delayed progress, but a heart-lung machine was created in the early 1950�s. Early results were not promising but the machine was taken over and improved by the Mayo Clinic. Donald Melrose, in England, and Viking Bjork, in Sweden, also built similar machines to allow open heart surgery. The result was to be an effective heart-lung machine that could take over the functions of the heart and lungs during operations so as to allow surgery on the human heart.

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2.0 Analysis of the order of discovery in the history of medicine

The question of the origin of infectious disease was in dispute for thousands of years, the matter not being settled until the late 19th century. The earliest cultures and civilizations considered the cause of diseases to be supernatural and the appropriate remedies to be appeals to the Gods and magical incantations. Such beliefs were perfectly reasonable based upon the knowledge available to our pre- historic ancestors and to early civilizations. They had no awareness of bacteria, viruses or other microscopic organisms. Given that beliefs in Gods were used to explain other mysterious events, such as earthquakes, storms and volcanic eruptions, the Gods were an obvious explanation of disease. Given also that diseases can kill human beings, it would be reasonable to assume they are caused by powerful beings, like Gods or powerful demons and evil spirits. As the body automatically tends to repair itself, due to the immune system, it must have appeared to our pre-historic ancestors that on occasions the magical incantations and appeals to the Gods had worked. When the patient died the death could be put down to the capriciousness of the Gods or the great power of the evil spirit, rather than there being anything wrong with the treatment used.

In the west, from the time of Hippocrates, natural causes of diseases, such as the four humors theory, were the favoured explanation, although supernatural explanations continued to find acceptance. The same situation existed in China with natural causes of disease such as inadequate or imbalanced Qi and Yin and Yang being considered to be the causes of disease. A similar situation existed in India where a balance of the three elements, air, bile and phlegm was required for good health. The Greek, Chinese and Indian explanations of disease are quite similar all involving imbalances in bodily substances and all acquired a status that made them impervious to criticism and a block on innovation.

The presence of blood, urine, vomit and diarrhoea clearly shows the body has many internal fluids. Vomit and diarrhoea particularly seem to be present at times of sickness and recovery often occurs after vomiting and diarrhoea so that it would appear that getting rid of fluids from the body could cure sickness. Even bleeding was often followed by recovery from injury so that a limited loss of blood could be seen as promoting recovery. It is because the human body has these fluids and because getting rid of the fluids with vomiting, diarrhoea and bleeding seemed to cure sickness and injury, ideas such as an imbalance of fluids caused ill health arose in Western, Chinese and Indian cultures. This gave rise to theories such as Hippocrates and Galen�s four humors theory and to remedies such as bleeding and purging. The Chinese theory of an imbalance between Yin and Yang causing disease appears to be a more abstract version of the same idea. Given the knowledge of non-scientific societies these theories make good sense. A theory that micro-organisms, invisible to the naked eye, cause disease is hardly credible for societies that have no evidence of the existence of the micro-organisms. On the other hand, bodily fluids plainly do exist and their removal from the human body seems to be associated with recovery from disease and injury.

The medicine of Hippocrates and Galen did not just relate to the four humors. It also dealt with qualities such as hot, cold, dry and wet. This is because many of the symptoms of disease relate to these qualities for example if a person has a temperature or fever, they are hot, if they are perspiring, they are wet. If they do not have a temperature, they are cold, if they are not perspiring, they are dry. Galen�s theory was built up from the way the human body acts, both when it is sick and when it is healthy. If the human body functioned in a different way, it would have led to a different type of medical theory. If for example the human body changed color when it was sick, rather than changing temperature, medical theory would likely involve explanations and treatments that involve colors with the aim of restoring the patient to his or her normal healthy color.

The traditional Chinese theory of medicine has considerable similarities to the classical theories of Galen. The western idea of pneuma, a vital spirit taken into the body by breathing, is similar to the Chinese concept of Qi. Galen�s theory of the four humors considers much sickness is caused by an imbalance in the body fluids. The Chinese theory also deals with body fluids, known as JinYe. A healthy person will have the body fluids in balance, but if the body fluids are deficient, or if there is an accumulation of fluids, sickness can result. A further similarity between Galen�s humoral theory and the Chinese theory is that the Chinese theory of Yin and Yang, like the humoral theory considers sickness is caused by imbalances within the body. The Chinese theory of blood also emphasizes that imbalances can cause sickness. Given that Yin and Yang, body fluids and blood should all be in balance to avoid sickness in Chinese medical theory, it has considerable similarities with Galen�s humoral theory which considers sickness is caused by imbalances in the four humors. In both the humoral theory and traditional Chinese medicine the weather could cause imbalances in body fluids.

A further similarity between Galen�s theory and traditional Chinese medicine concerns the elements. Galen�s theory uses the idea of the four Greek elements, air, fire, earth and water. Each element is associated with a particular organ, a particular humor and with the qualities of hot, cold, dry and wet. Water for example is associated with the organ, the brain, the humor phlegm and the qualities of cold and wet. Traditional Chinese medicine uses the Chinese elements of fire, earth, water, wood and metal. The elements are each associated with organs, one of which is a Yin organ and the other a Yang organ. Water for example is associated with the bladder and the kidney, while earth is associated with the stomach and the spleen. The elements are all interconnected so that if one of the organs and its element is in a state of imbalance, it will affect the other elements and their organs. This could affect the individual�s facial color and emotional state as well as the functioning of the relevant organs. The Western and Chinese theories of medicine were so similar, because each was derived from the same source. The source was the human body and the environment that could affect the human body. If the human body and the environment were different the theories would be different.

The naturalistic and supernatural explanations of disease co-existed for thousands of years, sometimes with one dominant, and at other times, the other being the more powerful. Neither was more convincing than the other, in that both sometimes appeared to work and that both sometimes failed to work. When they failed to work, both the supernatural and naturalistic theories provided explanations for the failure. If the human body did not have an immune system, so that if a person got sick they inevitably died and the incantations to the Gods and the treatment provided by doctors never worked, then the supernatural and naturalistic explanations of disease and the treatments they gave rise to would never have existed. It is only because the human body fights against disease, often successfully, that the incantations to the Gods and doctor�s treatments often appeared to be successful which suggested that the explanations of disease were true and the treatments provided were sometimes working. Both the supernatural and naturalistic explanations of disease could have been proved wrong with modern double blind testing, but such testing was not done in the past because it required knowledge of sophisticated statistical techniques that only became available in the last 400 years. Even in the 18th century the English and French were unable to agree as to whether smallpox inoculation was desirable, while in the first half of the 19th century Pierre Louis conducted trials which showed bleeding was a useful treatment. Even today, drug trials sometimes produce contradictory results. Even if testing had been done the theories would probably have survived due to the lack of serious alternatives.

It was not until the late 19th century with the development of the germ theory of disease that the question of the origin of infectious disease was settled in favour of a naturalistic theory, but a theory completely different from any of the naturalistic theories previously accepted. When Fracastorius in the 16th century suggested contagious disease was caused by tiny seeds invading the human body, the theory was quite reasonably not accepted, as there was no evidence of the existence of the tiny seeds, or that they caused disease. Fracastorius theory was almost identical to the germ theory of disease and the germ theory was only accepted in the late 19th century with the work of Pasteur and Koch. Leeuwenhoek had discovered micro-organisms in the late 17th century but that did not mean that they caused disease. In fact, the vast majority of micro-organisms do not cause disease in humans. It was only with the more powerful 19th century microscopes that Pasteur and Koch were able to discover particular organisms which caused particular diseases in humans. They were able to show the organisms were the causes of the disease by isolating the organisms and by preparing a pure culture of the organism, which in the case of animals would then be injected into an animal causing the disease in the animal. This procedure known as Koch�s postulate established the germ theory of disease and was able to show which particular germs caused which disease.

The explanations of infectious disease were based upon the knowledge available to a society at a particular time. When that knowledge changed (the discovery of micro-organisms and the discovery that some of them cause disease) the explanations of disease changed. Societies that considered the activities of supernatural beings as explaining otherwise inexplicable phenomena used supernatural explanations for the cause of infectious diseases. Supernatural explanations and naturalistic explanations of disease co-existed for thousands of years. Each was as convincing as the other until the germ theory of disease arose in the late 19th century. Naturalistic explanations of disease were based upon the natural world, and in particular, on the human body itself. Body fluids, organs and the elements of the natural world all had a prominent role in both Western and Chinese naturalistic explanations of disease.�

The Chinese and Western explanations of disease were similar because they had similar knowledge of the natural world and of the human body, so they developed similar theories to explain the origin of disease. If the natural world and the human body were different, then the theories explaining disease would have been different. When human knowledge of the natural world increased, with the discovery of micro-organisms in the 17th century and the discovery in the late 19th century that some of those micro-organisms caused disease in humans, the theories explaining the causes of disease changed. The germ theory of disease became the accepted explanation of infectious disease throughout the western world. The practice of immunization (the modern name for vaccination, also known as inoculation) has been one of the most successful medical practices in history. It has been responsible for an enormous reduction in human suffering and has saved an enormous number of human lives. The injection of dead bacteria or their toxins, or dead or weakened viruses into the human body to create immunity against disease, has eliminated or controlled a considerable range of diseases. Immunization has been used successfully against anthrax, bubonic plague, chicken pox, cholera, diphtheria, Haemophilus influenza type B, mumps, paratyphoid fever, pneumococcal pneumonia, poliomyelitis, rabies, rubella (German measles), Rocky Mountain spotted fever, smallpox, tetanus, typhoid, typhus, whooping cough and yellow fever.

Immunization works because the body�s natural defenses against infection are able to remember dangerous bacteria and viruses they have already had contact with and are able to react more quickly and more strongly to later infections from the same organism. When an infection occurs certain cells in the body respond by moving to destroy the invading bacteria or viruses. In order to destroy the invading bacteria or viruses the body�s immune system, a collection of free moving cells, has to recognize which materials in the body are foreign invaders and what is part of the body. It does this by matching the shape of receptors on the surface of defending cells to the shape of the surface of the invading organism and if they fit together the defending cells recognizes an invading organism. Once recognition of an invader has taken place other defending cells will attack and destroy the invading organisms. The defending cells can also produce memory cells which, in the event of a future invasion by the same organisms, are able to immediately clone large numbers of the appropriate defending cells to attack the invading organism, without having to go through the process of recognizing the invading organism.

This makes the immune systems response to invading organisms, which it has recognized before, much stronger, faster and more effective. This process known as the amplification of the response is the basis for immunization. A dead or greatly weakened infectious organism is injected into the human body so that the defending cells will remember the organism, so that in a future attack the immune system does not have to go through the recognition process and can immediately attack the invading organisms with large numbers of cloned defending cells. If the body did not work in this manner, for example if it did not produce memory cells which instantly recognize invading organisms, the process of immunization would not work. This would mean that the wide range of diseases immunization is effective against would still be killing vast numbers of people.

Smallpox was the first infectious disease to be treated with immunization, partly because it was one of the worst and most persistent diseases in history and partly because nature provided a ready-made immunizing material, in the form of cowpox, which saved people from having to identify, isolate and produce a safe vaccine. The high mortality rate from smallpox and the observation that survivors were protected from future attacks, which could only be observed with a disease which was continually or often present made smallpox the obvious disease to immunize against. A disease which came and then disappeared often for centuries is a less urgent case to immunize against as it may well not come back for centuries making immunization unnecessary. Given that smallpox was often or continually around it made sense to immunize against it. It also made it more easily observable that survivors were protected against future attacks. This was not so easily observable with diseases which involved major epidemics and then disappeared for long periods of time, so there were no future attacks from which the victims of earlier attacks could be shown to be immune. However early attempts at variolation were so dangerous, that it is not surprising that it never really caught on.

The reason why smallpox was the first disease effectively treated with immunization was because nature provided, in cowpox, a ready-made vaccination material which was not dangerous to human beings. To produce effective vaccines for other diseases it was necessary to discover the bacteria or virus involved, to isolate it and to reproduce it. This process enunciated in Koch�s postulates could only be done with better microscopes than was available in the 18th century. It also needed the understanding that germs cause infectious disease which was not established until late in the 19th century by Pasteur and Koch. This understanding was not needed for smallpox, where it could be empirically observed, even by milkmaids, that the natural vaccine, cowpox, prevented smallpox.� With the other diseases it was necessary to understand the germ theory of disease and then to artificially produce a vaccine before it was possible to immunize against those diseases. The process of immunizing against smallpox was a lot simpler than the process of immunizing against other diseases, so immunization against smallpox occurred before immunization against the other diseases.

The taboo on human dissection applied in most human societies, except India, Ancient Egypt and Europe since the Renaissance. The result was substantially erroneous beliefs concerning human anatomy and physiology. Beliefs that the heart was the centre of thought, sense perception and controlled bodily movements, while the brain cooled the heart and blood held by Aristotle resulted from the taboo on human dissection. When the taboo was not present, such as in Alexandria during the Ptolemaic era, it was discovered, that the brain dealt with sense perception and bodily movements. Further progress in anatomy and physiology was delayed until the Renaissance when some dissections of the corpses of executed criminals was allowed. This eventually resulted in the anatomical discoveries of Versalius and the circulation of the blood by Harvey. Many future developments in medicine, especially in surgery, were dependent upon the new knowledge of anatomy and physiology obtained from the lifting of the taboo on human dissection.

Progress in surgery was also dependent on the discovery of anaesthesia and anti-septic and a- septic practices. There were two main consequences from the discovery of anaesthesia. The first was that surgery became far more common as patients no longer tried to avoid it. The second was that surgical operations became a lot longer with emphasis being on precision and accuracy rather than on speed. With increasing time being spent on operations more intricate and complex operations could be performed which greatly widened the range of operations available. With much longer operations and the need for anaesthetics and anaesthetists the cost of operations went up as did the status of surgeons who were now able to do so much more for their patients. Surgery became a practical solution to many medical problems.

The idea that cleanliness was important to stop infections in surgery and obstetrics was only accepted after Pasteur had established the germ theory of disease which showed that bacteria in the air caused infections. Prior to the germ theory of disease being accepted suggestions that cleanliness was important, were ignored as there seemed to be no reason why cleanliness could stop infection or lack of cleanliness could cause infection. The discovery that infection was caused by bacteria in the air, led to the anti-septic idea of killing the bacteria to stop infection and then to the a-septic idea of sterilising everything that came in contact with the patient.

The ending of the taboo on human dissection resulted in vastly improved knowledge of anatomy and physiology, this, and the discovery of anaesthesia and the realisation of the importance of a-septics, formed the basis of modern surgery. Only when these developments came together, was it possible for modern surgery, with its sophisticated and intricate operations, to become a reality. This led to new types of surgery which had never before been developed such as abdominal and brain surgery. Plastic surgery, which had been practiced crudely in the past, improved enormously and later led to cosmetic surgery. Hip replacement operations were developed after the invention of a practical artificial hip. Organ transplants began when surgical techniques were developed for joining small blood vessels and when the problem of rejection of donated organs was solved by the development of appropriate drugs. Kidney transplants developed rapidly after the invention of the kidney dialysis machine as it is a relatively simple operation and because there is a better supply of donated kidneys as human beings have two kidneys and only need one so as to allow transplants from living donors. Open heart surgery and heart transplants were developed after the invention of the heart-lung machine to keep the patient alive during surgery.

The use of anti-biotics in medicine is only possible because nature provides such organisms that inhibit the growth of bacteria and allows the production of synthetic compounds that achieve the same result. If nature did not provide these organisms, or allow such compounds, there would have been no anti-biotics used in medicine. Without anti-biotics, medicine since the 1940�s would have been much less effective and hundreds of millions, who were cured of infections, would have died. The discovery and use of anti-biotics was impossible before the development of microscopes capable of observing bacteria. Only when such microscopes existed was it possible to observe that certain organisms were capable of killing or inhibiting bacteria. A number of such observations were made in the late 19th and early 20th century and eventually it was realised that penicillin, a substance taken from one of those bacteria killing organisms, could be used against infectious disease. When penicillin was proved to be effective, a systematic search was made for other anti-biotics which resulted in the discovery of a number of other anti-biotics. However, it was only because nature has provided the anti-biotics that we have them, and we have only had them, since we acquired the knowledge of their existence and of how to use them.

The use of statistics in medicine has been of enormous use in showing the causes of disease and in assessing the effectiveness of treatments. Yet statistics are never able to provide a perfect answer to questions of drug effectiveness and the causation of disease. They may show a co-relation between two variables, for example people living close to the sea have higher rates of cholera, than people further from the sea. This does not however mean that proximity to the sea causes cholera. Co-relation does not prove causation as the correlated variable may be caused by a third factor, such as polluted river water which is more common closer to the sea. The third factor, often called a lurking variable, may well not be considered in the data so no effort is made to compare cholera rates among people drinking polluted water close to the sea with those drinking clean water close to the sea. If the comparison was made it would show that it was the quality of drinking water rather than proximity to the sea that was the important variable concerning cholera rates. When trying to discover the cause of increasing lung cancer after World War II, air pollution and asphalting of roads were considered likely causes as both were increasing at the time lung cancer rates were increasing. Working out, which variable to study, when trying to discover the causes of disease, can be very difficult.

A further problem concerns trying to ensure the chosen sample is representative of the population which is being studied. Pierre Louis concluded bleeding was a useful treatment, but one of the groups he studied was substantially younger than another group. The sample must also be of sufficient size or simple co-incidence and high margins of error may provide misleading results. Pierre Louis� study of bleeding was criticized for having insufficient numbers in his sample.

Given the difficulties of doing good statistical studies it is not surprising that the causes of diseases and the effectiveness of treatments were never accurately assessed until recently. Modern statistical methods were only developed in the 17th, 18th and 19th centuries and arose from probability theory. It was only with the development of modern statistical methods that it has been possible to identify the causes of many diseases and to evaluate the effectiveness of treatments. Even with modern statistical methods the causes of some diseases, for example some cancers, are still difficult to pinpoint. Often different studies of the same phenomena will produce different results. In these circumstances it was impossible for people in the past to discover the effectiveness of treatments and the real causes of disease until the discovery of modern statistical analysis.

Modern diagnostic technology began with the discovery of X-rays. X-rays however could not be discovered until certain earlier discoveries had been made. X-rays were discovered through the use of a Crookes tube which required prior discoveries of an efficient air pump to create a near vacuum in the tube and the ability to send an electric current through the tube. Only when these discoveries had been made was it possible to discover X-rays. The use of X-rays was eventually improved and extended by the use of contrasting media and eventually by CT scanners after the invention of computers.

X-rays are a form of electro-magnetic energy and are useful due to their property of being able to pass through matter of low density but not matter of high density. This allows X-rays to be used to produce photographs of the interior of the human body, which is why X-rays are so useful in medicine. It is only because nature has provided such a form of electro-magnetic energy that we have X-rays available to be used for medical diagnosis. If nature had not provided electro-magnetic radiation with that property, we could not have the ability to see inside the human body for medical purposes by means of X-rays.

Endoscopy only became practical when Hopkins and Hirschowitz discovered a practical method to make light travel around corners. It was only because such a method exists that we are able to have modern endoscopy, and modern endoscopy could not exist until the discovery of how to make light travel around corners. Endoscopy was further enhanced when Hopkins discovered that thin lenses of air gave much greater light transmission than thin lenses of glass, so as to allow much better endoscope photography. If such lenses did not provide improved light transmission, then endoscope photography might still not be practical.

Our brief examination of the history of medicine has shown how the environment relevant to medicine has affected the history of medicine. The relevant environment includes the human body, how the human body works, the diseases that attack the human body, how the materials in the environment affect the human body and how the body reacts to disease and injury. If the human body was different then the history of medicine would have been different. If, for example, there was no immune system, then a lot of the confusion concerning the effectiveness of treatments used in the past would not have existed. When patients treated with prayers, incantations, herbs, medicines, moxabustion and bleeding recovered, it looked as though the treatment had worked. If patients died all the time, as they would have if there was no immune system, it would have been clear all these treatments were failing and they would have been abandoned. If there was no immune system then modern treatments such as immunization would not work and would not be available. If the human body was different, the theories as to what went wrong with it when people got sick would have been different. Galen�s humoral theory and traditional Chinese theories were based on the human body and how it behaved in sickness and in health. If the body was different then those theories would have been different.

Anaesthesia was only possible as materials in the human environment had the property of making people so unconscious that they could not feel pain. X-rays were only possible as electro-magnetic energy of a certain wave length will pass through matter of low density but not matter of high density. Modern endoscopy is only possible because light can be made to travel around corners and thin lenses of air provide excellent light transmission. The use of anti-biotics is only possible due to bacteria killing organisms existing in the human environment and the ability to create compounds that will kill bacteria. The properties of materials and matter and forms of energy in the environment determine what is possible in medicine.

When knowledge of the environment relevant to medicine changed, this resulted in new theories, such as the brain being the centre of thought and emotions rather than the heart, the circulation of the blood and the germ theory of disease. These ideas were the logical explanations of the new knowledge that human beings had acquired, just as the previous theories were the logical explanations of the knowledge humans possessed at those times.� Increasing knowledge of the environment, relevant to medicine, also led to the development of new treatments such as anaesthetics and new drugs. The new theories and treatments inevitably had significant social and cultural consequences, such as greater life expectancy, reduced suffering and different attitudes concerning religious beliefs, all of which would themselves result in further social and cultural consequences.

Where taboos existed against the acquisition of new knowledge, such as the taboo on human dissection, then the acquisition of new knowledge will be delayed until the taboo is removed. This, in the case of medicine, meant erroneous ideas of human anatomy and physiology continued for as long as the taboo remained in place.� Only after the taboo was lifted was it possible to make the anatomical discoveries of Versalius and for Harvey to discover the circulation of the blood.

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2.1 The Origins and History of Medical Practice with Fundamentals of Medical Practice Management ^g

LIFELONG LEARNING

Practice management is changing rapidly in response to the ever-changing landscape of healthcare and the medical practice. Practice managers need to be committed to lifelong learning and be active in our professional organizations to ensure they are up-to-date on current knowledge.

The Medical Group Management Association (MGMA), with its academic arm, the American College of Medical Practice Executives (ACMPE), is the premier practice management education and networking group for practice managers. The organization dates back to 1926 and represents more than 33,000 administrators and executives in 18,000 healthcare organizations in which 385,000 physicians practice. MGMA (2016a) has been instrumental in advancing the knowledge of practice management, and ACMPE offers a rigorous certification program in practice management that is widely recognized in the industry.

ACMPE has identified eight areas that are essential for the practice manager to understand (exhibit 1.1).

This text examines each of these domains of the practice management body of knowledge to provide a sound, fundamental base for practice managers and practice leaders. It includes a comprehensive overview that does not assume a great deal of prior education in the field of practice management. Furthermore, it seeks to provide not only specific information about the management of the medical practice but also context in the larger US healthcare system. Too often, different segments of the healthcare system see themselves as operating in isolation. This point of view must change if medical practices are to transform and if managers are to lead successful practices in the future, whether a small, free-standing practice or a large practice integrated with a major healthcare system.

Another prominent organization for the education and advancement of practice management is the American College of Healthcare Executives (ACHE). ACHE is a professional organization of more than 40,000 US and international healthcare executives who Certification

A voluntary system of standards that practitioners meet to demonstrate accomplishment or ability in their profession. Certification standards are generally set by nongovernmental agencies or associations.

Business operations	Financial management
Human resource management	Information management
Organizational governance	Patient care systems
Quality management	Risk management

Source: MGMA (2016b).

Exhibit 1.1

THE EIGHT DOMAINS OF THE BODY OF KNOWLEDGE FOR PRACTICE MANAGERS

Natural healthcare systems, hospitals, and other healthcare organizations. Currently with 78 chapters, ACHE offers board certification in healthcare management as a Fellow of ACHE, a highly regarded designation for healthcare management professionals (ACHE 2016).

THE AMERICAN HEALTHCARE SYSTEM

The practice of medicine drives the US healthcare system and its components, and medicine is heavily influenced by the system as well. Medical practice and the healthcare system both are built on the foundation of the physician�patient relationship. Although the percentage of total healthcare costs attributed to physicians and other clinical practitioners was 20 percent in 2015, the so-called clinician�s pen, representing the prescribing and referral power of medical practice clinicians, indirectly accounts for most healthcare system costs.

Administrators do not prescribe medication; admit patients, or order tests and services. This fact is just one illustration of a fragmented system whose segments can act independently.

This fragmentation must be addressed if medical practices are to provide high-quality healthcare to patients at the lowest cost possible.

To begin our study of practice management, the book first offers some perspective of medical practices in terms of the overall US healthcare system. A complete history of the practice of medicine is beyond the scope of this text, but the lengthy and enduring nature of medical practice is important to recognize. The first known mention of the practice of medicine is from the Old Kingdom of Ancient Egypt, dating back to about 2600 BC.

BEHAVIOR

How an individual acts, especially toward others.

Later, the first known code of conduct, the Code of Hammurabi, dealt with many aspects of human behavior and, most importantly for our study, established laws governing the practice of medicine. The first medical text was written about 250 years later (Nunn 2002).

Exhibit 1.2 provides a sample of some significant points in the development of the physician medical practice from ancient times to the present. The reader may wonder why such a diverse series of events is listed, ranging from the recognition of the first physician to the occurrence of natural disasters and terrorist acts. Medicine, whether directly or indirectly, influences virtually every aspect of human life. Events such as Hurricane Katrina, the 9/11 terrorist attacks, the emergence of the human immunodeficiency virus (HIV), and the Ebola virus outbreak have had major impacts on the healthcare system and physician practice. Before 9/11, medical practices thought little about emergency preparedness and management; such activities were seen as under the purview of government agencies. Until HIV was identified in 1983 as the cause of acquired immunodeficiency syndrome (AIDS), and reinforced by the Ebola crisis of 2014, medical practices spent few resources and little time thinking about deadly infectious disease and the potential for it to arrive from distant locales. A traveler can reach virtually any destination in the world within a 24-hour period, which is well within the incubation period of most infectious agents. Modern air travel has made the world of disease a single place, so practices must be mindful of patients� origins and travels.

Exhibit 1.2

SELECTED MAJOR EVENTS IN THE HISTORY OF MEDICINE AND MEDICAL PRACTICE

2600 BC: Imhotep is a famous doctor and the first physician mentioned in recorded history. After his death he is worshiped as a god. (Hurry 1978)

1792�1750 BC: The Code of Hammurabi is written, establishing laws governing the practice of medicine. (Johns 2000)

1500 BC: The Ebers Papyrus is the first known medical book. (Hinrichs�sche, Wreszinski, and Umschrift 1913)

500 BC: Alcamaeon of Croton in Italy says that a body is healthy as long as it has the right balance of hot and cold, wet and dry. If the balance is upset, the body falls ill. (Jones 1979)

460�370 BC: Hippocrates lives. He stresses careful observation and the importance of nutrition. (Jones 1868)

384�322 BC: Aristotle lives. He says the body is made up of 4 humors or liquids: phlegm, blood, yellow bile, and black bile. (Greek Medicine.net 2016)

130�200 AD: Roman doctor Galen lives. Over following centuries, his writings become very influential. (Sarton 1951)

12th and 13th centuries: Schools of medicine are founded in Europe. In the 13th century, barber-surgeons begin to work in towns. The church runs the only hospitals. (Cobban 1999; Rashdall 1895)

1543: Andreas Vesalius publishes The Fabric of the Human Body. (Garrison and Hast 2014)

1628: William Harvey publishes his discovery of how the blood circulates in the body. (Harvey 1993)

1796: Edward Jenner invents vaccination against smallpox. (Winkelstein 1992)

1816: Rene Laennec invents the stethoscope. (Roguin 2006)

1847: Chloroform is used as an anesthetic by James Simpson. (Ball 1996)

1865: Joseph Lister develops antiseptic surgery. (Bankston 2004)

1870: The Medical Practice Act is passed. Licensure of physicians becomes a state function. (Stevens 1971)

1876: The American Association of Medical Colleges is founded. (Coggeshall 1965)

1880: Louis Pasteur invents a cure for chicken cholera, the first vaccine. (Debr� 2000)

Exhibit 1.2

SELECTED MAJOR EVENTS IN THE HISTORY OF MEDICINE AND MEDICAL PRACTICE

1895: Wilhelm Conrad R�ntgen X-rays are discovered. (Glasser 1933)

1910: The Abraham Flexner report on medical education is published. (Flexner 1910)

1928: Penicillin is discovered by Scottish scientist Alexander Fleming, and it is established that the drug can be used in medicine. (Ligon 2004)

1929: The first employer-sponsored health insurance is created at Baylor Teachers College as Blue Cross. (Buchmueller and Monheit 2009)

1931: The electron microscope is invented. (Palucka 2002)

1943: Willem Johan Kolff invents the first artificial kidney (dialysis) machine. (Heiney 2003)

1951: Epidemiology studies identify cigarette smoking as a cause of lung cancer. Sir Richard Doll is the first to make this link. (Keating 2009)

1953: Jonas Salk announces he has developed a vaccine for polio. (Koprowski 1960)

1953: The structure of DNA is determined. (Dahm 2008)

1965: Medicare and Medicaid are passed into Law. (Social Security Administration 2016)

1967: The first heart transplant is performed by Christiaan Barnard. (Barnard 2011)

1971: MRI scanning is invented. (Lauterbur 1973)

1973: The HMO Act is passed. (Dorsey 1975)

1989: President George W. Bush signs the Omnibus Budget Reconciliation Act of 1989, enacting a physician payment schedule based on a resource-based relative value scale. (AMA 2017)

1996: The Health Insurance Portability and Accountability Act is passed as an amendment to the HMO Act. (Atchinson and Fox 1997)

2001: The 9/11 terrorist attacks occur. (Bernstein 2003)

2003: The human genome is sequenced. (National Human Genome Research Institute 2010)

2005: Hurricane Katrina devastates the Gulf Coast, including New Orleans. (Knabb, Rhome, and Brown 2005)

2008: The Triple Aim for healthcare delivery is proposed by the Institute for Healthcare Improvement. (Berwick, Nolan, and Whittington 2008)

Exhibit 1.2

SELECTED MAJOR

EVENTS IN THE HISTORY OF MEDICINE AND MEDICAL PRACTICE

2008: Medicare Part D is enacted. (Hargrave et al. 2007)

2010: The Affordable Care Act is passed. (HHS 2010)

2012: High-deductible health plans become more common. (Bundorf 2012)

2014: The Ebola crisis emerges in West Africa. (CDC 2014)

2016: Zika virus becomes a serious health threat. (CDC 2016b; Wang and Barry 2016)

The evolution of medical practices has coincided with and been driven in part by the development of medical technology and the scientific revolution. Medicine was limited in scope and primitive until the middle of the nineteenth century. Theories of disease were arcane, and diagnostic tools were largely absent (Rosenberg and Vogel 1979).

Prior to 1850, medical education constituted an apprenticeship that was inconsistent and poorly preceptored, with no standard curriculum (Rothstein 1972). Procedures focused on expelling the disease with bleedings and emetics. Surgery was limited because of the lack of anesthesia, and as a result, being fast was better than being good. Patients often directed the physician as to the care they should receive. One might say early medical practice was the first iteration of patient-centered care (Burke 1985).

PRACTICE MANAGEMENT RESOURCES

Accounting

A system for keeping score in business, using dollars.

Now, however, the amount of information available about medicine and medical practice management is virtually endless, representing many points of view; ideas; political world views; notions about funding and access; and the numerous disciplines in the broader management field, such as accounting, finance, human resources management, organization development, and logistics. With the vast expanse of knowledge available, students of healthcare and practice management are encouraged to develop lifelong learning skills.

The field is changing so rapidly that the need for continuous updating of knowledge and skills is essential.

For example, practice managers need to build a virtual library of accurate and reliable sources. The list that follows comprises the foundation of that library, which should be referred to frequently (see the appendix to this text for each resource�s website):

◆ Centers for Medicare & Medicaid Services (CMS)

◆ Advisory Board

◆ Dartmouth Atlas

◆ National Committee for Quality Assurance

◆ Institute for Healthcare Improvement

◆ Institute of Medicine

◆ Institute for Health Policy and Innovation

◆ Kaiser Family Foundation

◆ Robert Wood Johnson Foundation

◆ Annenberg Foundation

◆ Commonwealth Fund

◆ Centers for Disease Control and Prevention

◆ Agency for Healthcare Research and Quality

THE DIMENSIONS OF MEDICAL PRACTICE

Governance

A system of policies and procedures designed to facilitate oversight of the management of the enterprise.

Serves as the foundation of how the practice will behave, compete, and document its actions.

Medical practices can take many forms, ranging from small sole proprietorships to large multispecialty medical practices. Recent years have seen more medical practices embedded in large healthcare organizations, which also may be solo practices or large multispecialty entities (see exhibit 1.3).

A group practice is defined as a medical practice consisting of two or more practitioners working in a common management and administrative structure. Single-specialty groups are those that focus on one aspect of medicine, such as general surgery, family practice, orthopedics, cardiology, or internal medicine. Multispecialty medical groups contain more than one medical specialty in the organization. Multispecialty practices are highly integrated, with a common governance leadership and common management structure, and they have a highly developed corporate system for managing finances and dealing with regulatory agencies. Their operation and function are much more complex than solo or small practices.

GOAL

A specific target that an individual or a company tries to achieve.

Integrated delivery systems (IDSs) are networks of healthcare organizations under a single holding company or parent organization that contain multiple components of healthcare delivery. An IDS often includes hospitals, physicians and other clinicians, and payment organizations, often referred to as third-party payer organizations. The goal is to provide as complete a continuum of care as possible.

Exhibit 1.3

PRACTICE

STRUCTURES�SIMPLE TO COMPLEX

Solo Practice � Group Practice � Integrated System��

TYPES OF PRACTITIONERS

Physicians have, of course, played a pivotal role in the US healthcare system since its inception. Physicians�and now, other non-physician providers such as nurse practitioners (discussed later)�care for patients by

◆ assessing the patient�s health status,

◆ diagnosing the patient�s condition, and

◆ prescribing and performing treatment.

It has been said that the most expensive instrument in the healthcare industry is the provider�s pen. An amusing statement, it also carries a lot of truth because all diagnostic and surgical procedures as well as office-based and hospital-based assessments�in fact, all care in general�is either performed or ordered by a provider.

Furthermore, the medical practice is unlike any other organization in the medical field because the nature and identity of the practice is closely linked to the individual providers in the practice. The providers are the primary producers and the primary governance body, and they are held accountable for the performance of the practice in a personal way. Their income is directly tied to the practice�s performance, more closely than for other medical field workers. Exhibit 1.4 shows the fundamental components of a medical practice.

Often, the challenge in practice management is to serve the interests of the providers while maintaining a focus on the patient, with patient focus being the True North of the practice.

Exhibit 1.4

THE PRACTICE MANAGEMENT MODEL

Continue to measure each step

Mission, Vision, and Values

�� |

Strategic Planning and Decision Making

�� |

�� Operations

�� |

�� Assessment

�� |

�� Process Improvement

True North

��True North� is a concept taken from Lean management that embodies the ideal state of a practice, its providers� vision of perfection, and the type and quality of practice it should strive to achieve every day. True North should transcend the individual and his or her personal goals or actions. Achieving personal objectives is not mutually exclusive but coincidental with True North.

Exhibit 1.5 shows the number of physicians practicing in the United States. This number can be further broken down into the number of practices by size and multispecialty versus single specialty, as shown in exhibit 1.6. Note the increasing size of practices over time, a trend that is expected to continue.

Exhibit 1.5

TOTAL ACTIVE PHYSICIANS IN THE UNITED STATES, APRIL 2017

Primary Care Physicians	Specialist Physicians	Total
443,962	479,346	923,308

Source: Kaiser Family Foundation (2017).

A primary care physician (PCP) is often the first contact for a patient with an undiagnosed health concern. In addition, PCPs frequently provide continuing care for many medical conditions that are not limited by cause, organ system, or diagnosis. This purview of practice differs from a medical specialist, who has completed advanced education and clinical training in a specific area of medicine and typically focuses on the diagnosis and treatment of one organ system of the body and its diseases.

Nurse practitioners and physician assistants are a growing segment of medical service provider, as seen in exhibit 1.7. A physician assistant (PA) is a nationally certified and state-licensed medical professional. PAs practice medicine with physicians and other providers and are allowed to prescribe medication in all 50 states, the District of Columbia, the majority of US territories, and the uniformed services. A nurse practitioner (NP) is a registered nurse qualified, through advanced training, to assume some of the duties and responsibilities of a physician.

PAs and NPs are sometimes referred to as advanced practice professionals or midlevel providers; however, the term mid-level provider is considered obsolete.

State laws vary as to the specific duties PAs and NPs are allowed to perform, so the practice manager must be fully informed on these regulations.

Advanced practice professionals are becoming increasingly important to medical practices because they can replace physicians in care delivery for many services, reserving the physician for more complex care requiring their expertise. For example, PAs and NPs often work as part of a care team with physicians. They may examine the patient first; collect facts and findings; and then, in collaboration with the physician, make a diagnosis

Exhibit 1.6

DISTRIBUTION OF SINGLE- AND MULTISPECIALTY PHYSICIANS BY PRACTICE SIZE, 2014

Number of Physicians in Practice	Single-Specialty Practice	Multispecialty Practice
1	1.5%	0.3%
2 to 4	42.0%	13.8%
5 to 10	31.7%	20.8%
11 to 24	13.7%	17.2%
25 to 49	6.7%	11.1%
50+	4.5%	36.9%
Total	100%	100%
N	1,452	836

Source: Kane (2014).

and develop a treatment plan. The physician supervises the process and conducts his or her own examination of the patients to ensure that the proper care is delivered. The physician often checks critical elements of the exam and establishes a relationship with the patient.

The PA or NP typically follows up with the patient once the treatment plan is established.

PRACTICE OWNERSHIP

In addition to the area of medicine practiced, physician practices can be classified by type of ownership. Exhibit 1.8 shows the distribution of medical practices by ownership.

Note the trend�also expected to continue�toward practice ownership by hospitals and healthcare systems.

LICENSING PHYSICIANS

All 50 states require physicians and medical providers to hold a license. The licensing of medical providers is performed under the auspices of a medical examining board. These boards have the right to grant a license to practice medicine and the responsibility to investigate and discipline providers in cases of inappropriate conduct.

LICENSURE

A mandatory system of state-imposed standards that practitioners must meet to practice a given profession.

These licenses provide the practitioner a general right and privilege to practice medicine, but they usually do not grant specific privileges to practice a particular medical specialty. This activity is beyond the scope of licensure and typically is conducted by the hospital or hospitals at which the physician or advanced practice provider delivers care.

The licensing process includes a thorough, painstaking review and verification of the training and experience the physician or provider has received. Criminal background checks and reviews of the National Practitioner Data Bank (NPDB) are conducted in this process.

The NPDB contains documentation of any disciplinary acts leveled against the physicia